Healthcare Provider Details

I. General information

NPI: 1629060108
Provider Name (Legal Business Name): ERIC J FU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17213 CORIANDER CT
YORBA LINDA CA
92886-6251
US

IV. Provider business mailing address

17213 CORIANDER CT
YORBA LINDA CA
92886-6251
US

V. Phone/Fax

Practice location:
  • Phone: 714-646-9830
  • Fax: 714-646-9830
Mailing address:
  • Phone: 714-646-9830
  • Fax: 714-646-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number20494
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: