Healthcare Provider Details

I. General information

NPI: 1245094150
Provider Name (Legal Business Name): KWUN MAN SIMON YU DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N LARK ELLEN AVE STE M
WEST COVINA CA
91791-1099
US

IV. Provider business mailing address

855 N LARK ELLEN AVE STE M
WEST COVINA CA
91791-1099
US

V. Phone/Fax

Practice location:
  • Phone: 626-878-5233
  • Fax: 626-779-9225
Mailing address:
  • Phone: 626-878-5233
  • Fax: 626-779-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: