Healthcare Provider Details

I. General information

NPI: 1578191441
Provider Name (Legal Business Name): RICHARD XIRAN YU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 A ST UNIT 1536
TACOMA WA
98402-5001
US

IV. Provider business mailing address

1102 A ST UNIT 1536
TACOMA WA
98402-5001
US

V. Phone/Fax

Practice location:
  • Phone: 317-645-3628
  • Fax:
Mailing address:
  • Phone: 317-645-3628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.MD.70107857
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01089836A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: