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Individual
YI BU
Active
Individual
YI BU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
51912
CA
Other
Enumeration date
09/15/2014
Last updated
09/15/2014
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