Provider Demographics
NPI:1356826689
Name:NEWPORT UROLOGIC ONCOLOGY A MEDICAL GROUP
Entity Type:Organization
Organization Name:NEWPORT UROLOGIC ONCOLOGY A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOSHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-999-8979
Mailing Address - Street 1:1525 SUPERIOR AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3656
Mailing Address - Country:US
Mailing Address - Phone:949-999-8979
Mailing Address - Fax:949-999-8970
Practice Address - Street 1:1525 SUPERIOR AVE STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3656
Practice Address - Country:US
Practice Address - Phone:949-999-8979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty