Provider Demographics
NPI:1407248453
Name:YJH MEDICAL PC
Entity Type:Organization
Organization Name:YJH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MACSWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-501-5501
Mailing Address - Street 1:1 COLOMBA DR STE 2
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1275
Mailing Address - Country:US
Mailing Address - Phone:716-501-5501
Mailing Address - Fax:716-215-6400
Practice Address - Street 1:1 COLOMBA DR STE 2
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1275
Practice Address - Country:US
Practice Address - Phone:716-501-5501
Practice Address - Fax:716-215-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-28
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty