Provider Demographics
NPI:1508187063
Name:LOGAN, YEWAH JUNG (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:YEWAH
Middle Name:JUNG
Last Name:LOGAN
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:DR
Other - First Name:YEWAH
Other - Middle Name:
Other - Last Name:JUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO MPH
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5500 CAMPANILE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92182-0001
Practice Address - Country:US
Practice Address - Phone:619-594-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13987207Q00000X, 207Q00000X
TXP7655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine