Provider Demographics
NPI:1306404413
Name:GUAM DERMATOLOGY INSTITUTE LLC
Entity Type:Organization
Organization Name:GUAM DERMATOLOGY INSTITUTE LLC
Other - Org Name:GUAM DERMATOLOGY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSEONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:671-588-5001
Mailing Address - Street 1:633 GOV CARLOS G CAMACHO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3143
Mailing Address - Country:US
Mailing Address - Phone:671-588-5001
Mailing Address - Fax:671-649-5003
Practice Address - Street 1:633 GOV CARLOS G CAMACHO RD STE 102
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3143
Practice Address - Country:US
Practice Address - Phone:671-588-5001
Practice Address - Fax:671-649-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty