Healthcare Provider Details

I. General information

NPI: 1003959248
Provider Name (Legal Business Name): CECILIA H YU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROGRESS POINT PKWY STE 220
O FALLON MO
63368-2206
US

IV. Provider business mailing address

PO BOX 7412027
CHICAGO IL
60674-2027
US

V. Phone/Fax

Practice location:
  • Phone: 636-344-3333
  • Fax: 636-344-3334
Mailing address:
  • Phone: 636-344-3333
  • Fax: 636-344-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number110486
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: