Healthcare Provider Details

I. General information

NPI: 1851827323
Provider Name (Legal Business Name): PETER YU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5996 E 64TH AVE
COMMERCE CITY CO
80022-3317
US

IV. Provider business mailing address

PO BOX 746081
ATLANTA GA
30374-6081
US

V. Phone/Fax

Practice location:
  • Phone: 720-463-6758
  • Fax: 720-640-3314
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22471
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0004363-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: