Healthcare Provider Details

I. General information

NPI: 1861671976
Provider Name (Legal Business Name): SUSAN SHU MEI YU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 VAN NESS AVE SUITE 210
SAN FRANCISCO CA
94102-6020
US

IV. Provider business mailing address

30 VAN NESS AVE. SUITE 210 MCAH, 30
SAN FRANCISCO CA
94102-2116
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-1339
  • Fax: 415-440-6423
Mailing address:
  • Phone: 415-575-5732
  • Fax: 415-575-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number547568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: