Provider Demographics
NPI:1477741858
Name:CLARA PH YONG MD INC
Entity Type:Organization
Organization Name:CLARA PH YONG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:PH
Authorized Official - Last Name:YONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-263-7411
Mailing Address - Street 1:30 AULIKE ST.
Mailing Address - Street 2:SUITE 405
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2751
Mailing Address - Country:US
Mailing Address - Phone:808-263-7411
Mailing Address - Fax:808-263-7455
Practice Address - Street 1:30 AULIKE ST.
Practice Address - Street 2:SUITE 405
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2751
Practice Address - Country:US
Practice Address - Phone:808-263-7411
Practice Address - Fax:808-263-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00C0052666OtherHMSA
HI04633103Medicaid
00C0052666OtherHMSA
HI56256Medicare PIN