Healthcare Provider Details

I. General information

NPI: 1538035233
Provider Name (Legal Business Name): YU LENG PHUA PHD, FACMG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INDUSTRIAL RD
SAN CARLOS CA
94070-2396
US

IV. Provider business mailing address

1710 KENTFIELD AVE
REDWOOD CITY CA
94061-2707
US

V. Phone/Fax

Practice location:
  • Phone: 408-780-9975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number2021006
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number2025032
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number2025032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: