Provider Demographics
NPI:1417062167
Name:YONG, MARJORIE MEIJI (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:MEIJI
Last Name:YONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16628 OAK VIEW CT
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1900
Mailing Address - Country:US
Mailing Address - Phone:310-989-1892
Mailing Address - Fax:818-789-0208
Practice Address - Street 1:5400 BALBOA BLVD STE 212
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5209
Practice Address - Country:US
Practice Address - Phone:818-789-0203
Practice Address - Fax:818-789-0208
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0007134338OtherAETNA PROVIDER NUMBER
CA11431045OtherCAQH ID #
CA5596075OtherCCN/FIRST HEALTH
CA00A614060OtherBLUE SHIELD PROVIDER ID #
CA00A614060OtherBLUE SHIELD PROVIDER ID #
CAH01954Medicare UPIN
CAW18890Medicare ID - Type UnspecifiedGROUP ID NUMBER