Basic Information
| Provider Information | |||||||||
| NPI: | 1922495209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YU | ||||||||
| FirstName: | KRYSTINA | ||||||||
| MiddleName: | SANG | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SANG | ||||||||
| OtherFirstName: | KRYSTINA | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6431 FANNIN ST STE JJL 324 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135007600 | ||||||||
| FaxNumber: | 7135007619 | ||||||||
| Practice Location | |||||||||
| Address1: | 4755 ALDINE MAIL RTE | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770395934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819857600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2015 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 46298 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | T0398 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.