Basic Information
| Provider Information | |||||||||
| NPI: | 1356399133 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YUH | ||||||||
| FirstName: | JENG | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 N KINGSLEY DR | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900044321 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7259 S BINGHAM JUNCTION BLVD | ||||||||
| Address2: | |||||||||
| City: | MIDVALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019303000 | ||||||||
| FaxNumber: | 8665882820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 03/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 271213 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 60630 | MN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | A86391 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 110127207A | 05 | MA | MEDICAID |