Provider Demographics
NPI:1508045295
Name:PACIFIC SLEEP LAB INC
Entity Type:Organization
Organization Name:PACIFIC SLEEP LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:INCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YEAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN
Authorized Official - Phone:949-366-2701
Mailing Address - Street 1:675 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2835
Mailing Address - Country:US
Mailing Address - Phone:949-366-2701
Mailing Address - Fax:949-429-6918
Practice Address - Street 1:675 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2835
Practice Address - Country:US
Practice Address - Phone:949-366-2701
Practice Address - Fax:949-429-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATG252261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic