Provider Demographics
NPI:1386685873
Name:YOCHANAN, SOLOMON METHUSELACH (MD)
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:METHUSELACH
Last Name:YOCHANAN
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:PO BOX 721344
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92172-1344
Mailing Address - Country:US
Mailing Address - Phone:202-774-8655
Mailing Address - Fax:
Practice Address - Street 1:1117 E DEVONSHIRE AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3083
Practice Address - Country:US
Practice Address - Phone:951-766-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77979207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00158920OtherRAILROAD MEDICARE
CA00G779790OtherBLUE SHIELD
CA00G779790Medicaid
CA00G779790Medicaid
CAP00158920OtherRAILROAD MEDICARE