Provider Demographics
NPI:1063305936
Name:YU, LUNA
Entity type:Individual
Prefix:
First Name:LUNA
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 SW 174TH AVE APT 413
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-4601
Mailing Address - Country:US
Mailing Address - Phone:503-572-7404
Mailing Address - Fax:
Practice Address - Street 1:3575 SW 174TH AVE APT 413
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-4601
Practice Address - Country:US
Practice Address - Phone:503-572-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver