=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073791513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENSON W. YU M.D. PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2008
-----------------------------------------------------
Last Update Date | 05/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3601 CHAIN BRIDGE RD STE D
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-3243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-691-1136
-----------------------------------------------------
Fax | 703-691-8116
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3601 CHAIN BRIDGE RD STE D
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-3243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-691-1136
-----------------------------------------------------
Fax | 703-691-8116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BENSON W YU
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 703-691-1136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0101048810
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------