Healthcare Provider Details

I. General information

NPI: 1538334289
Provider Name (Legal Business Name): WON K YU MD MPH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17400 IRVINE BLVD STE F
TUSTIN CA
92780-3030
US

IV. Provider business mailing address

230 S MAIN ST STE 215
ORANGE CA
92868-3851
US

V. Phone/Fax

Practice location:
  • Phone: 714-937-9400
  • Fax: 714-937-9404
Mailing address:
  • Phone: 714-937-9400
  • Fax: 714-937-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA77275
License Number StateCA

VIII. Authorized Official

Name: WON KYE YU
Title or Position: OWNER
Credential: M.D.
Phone: 714-937-9400