Provider Demographics
NPI:1134330921
Name:YILMAZ DEMIRDAG, YESIM (MD)
Entity Type:Individual
Prefix:
First Name:YESIM
Middle Name:
Last Name:YILMAZ DEMIRDAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YESIM
Other - Middle Name:
Other - Last Name:DEMIRDAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9214
Mailing Address - Street 2:WEST VIRGINIA UNIVERSITY
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9214
Mailing Address - Country:US
Mailing Address - Phone:304-293-1201
Mailing Address - Fax:
Practice Address - Street 1:821 HEALTH SCIENCES RD MEDICAL SCIENCES I C-240
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-9214
Practice Address - Country:US
Practice Address - Phone:949-824-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC166841207K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07225Medicaid