Healthcare Provider Details

I. General information

NPI: 1528815982
Provider Name (Legal Business Name): YVETTE LU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 W BAXTER DR STE 100
SOUTH JORDAN UT
84095-8506
US

IV. Provider business mailing address

11100 S RIVER HEIGHTS DR APT B110
SOUTH JORDAN UT
84095-6211
US

V. Phone/Fax

Practice location:
  • Phone: 571-765-3233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: