Healthcare Provider Details

I. General information

NPI: 1720614787
Provider Name (Legal Business Name): SHENGYANG KEVIN YU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N JACKSON AVE
SAN JOSE CA
95116-1603
US

IV. Provider business mailing address

6317 9TH AVE NE UNIT D
SEATTLE WA
98195-2204
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-5000
  • Fax:
Mailing address:
  • Phone: 206-598-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA210769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: