Healthcare Provider Details

I. General information

NPI: 1083176317
Provider Name (Legal Business Name): IRENE YU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11803 SOUTH FWY STE 315
BURLESON TX
76028-7036
US

IV. Provider business mailing address

11803 SOUTH FWY STE 315
BURLESON TX
76028-7036
US

V. Phone/Fax

Practice location:
  • Phone: 682-224-3748
  • Fax: 682-841-0039
Mailing address:
  • Phone: 682-224-3748
  • Fax: 682-841-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberV8814
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberV8814
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: