Provider Demographics
NPI:1093815110
Name:YINGER, KENT ESTES (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:ESTES
Last Name:YINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CONCOURSE BLVD
Mailing Address - Street 2:#1
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8210
Mailing Address - Country:US
Mailing Address - Phone:707-544-3400
Mailing Address - Fax:707-544-0137
Practice Address - Street 1:208 CONCOURSE BLVD
Practice Address - Street 2:#1
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8210
Practice Address - Country:US
Practice Address - Phone:707-544-3400
Practice Address - Fax:707-544-0137
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA555050174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A55505Medicaid
CA00A55505Medicare ID - Type Unspecified
CA00A55505Medicaid