Healthcare Provider Details

I. General information

NPI: 1750744967
Provider Name (Legal Business Name): SHI YU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 300
NEWPORT BEACH CA
92663-3668
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 949-474-5722
  • Fax:
Mailing address:
  • Phone: 949-474-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA151351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: