Basic Information
| Provider Information | |||||||||
| NPI: | 1538421961 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YU | ||||||||
| FirstName: | JIADE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 STANIFORD ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177262914 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 STANIFORD ST | ||||||||
| Address2: | DERMATOLOGY 2ND FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043019948 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2012 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 270837 | MA | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 61884 - 20 | WI | N | Allopathic & Osteopathic Physicians | Dermatology | 207NP0225X | MD457272 | PA | N | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology | 208000000X | L-251567 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207NP0225X | 270837 | MA | Y | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology |
No ID Information.