MEDICARE: DR. YVETTE JU D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	HOO64991	MD

General Provider Information

NPI Number	:	1033328539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVETTE JU D.O.

Provider Business Mailing Address
First Line	:	137 ARCHIMEDES CT
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21208-1095
Country	:	US
Telephone Number	:	410-486-8394
Fax Number	:

Provider Business Practice Location Address
First Line	:	6495 NEW HAMPSHIRE AVE
Second Line	:	SUITE 201
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3245
Country	:	US
Telephone Number	:	240-994-4356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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