Healthcare Provider Details

I. General information

NPI: 1538421961
Provider Name (Legal Business Name): JIADE YU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9109 STONY POINT DR
RICHMOND VA
23235-1979
US

IV. Provider business mailing address

9109 STONY POINT DR
RICHMOND VA
23235-1979
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD457272
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number0101286244
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL-251567
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101286244
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number270837
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number61884 - 20
License Number StateWI
# 7
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number270837
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: