Provider Demographics
NPI:1376812800
Name:TIMOTHY GUAN-TYNG YEH, M.D. INC.
Entity Type:Organization
Organization Name:TIMOTHY GUAN-TYNG YEH, M.D. INC.
Other - Org Name:TIMOTHY G. YEH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:YEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-956-4958
Mailing Address - Street 1:PO BOX 5256
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92838-0256
Mailing Address - Country:US
Mailing Address - Phone:714-956-4958
Mailing Address - Fax:714-400-0488
Practice Address - Street 1:29798 HAUN RD
Practice Address - Street 2:SUITE NUMBER 106
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6541
Practice Address - Country:US
Practice Address - Phone:714-956-4958
Practice Address - Fax:714-400-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G81650174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G816500Medicare PIN
CAH11016Medicare UPIN