MEDICARE: COMPREHENSIVE CARDIAC DIAGNOSTICS AND WELLNESS PLLC

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	207RC0000X	Cardiovascular Disease Physician	J7735	TX

General Provider Information

NPI Number	:	1295173680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE CARDIAC DIAGNOSTICS AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	10223 BROADWAY STREET
Second Line	:	SUITE: P-226
City	:	PEARLAND
State	:	TX
Zip	:	78584
Country	:	US
Telephone Number	:	281-886-4183
Fax Number	:	713-436-3489

Provider Business Practice Location Address
First Line	:	1930 COUNTRY PLACE PKWY STE 106
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-2138
Country	:	US
Telephone Number	:	281-506-7840
Fax Number	:	832-672-7485

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	JOHN C. L. YU
Credential	:	MD
Telephone Number	:	281-506-7840

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	12/19/2017

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