Provider Demographics
NPI:1558351379
Name:YEH, MARK M (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:YEH
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
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Mailing Address - Street 1:223 N 1ST AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7089
Mailing Address - Country:US
Mailing Address - Phone:626-821-1411
Mailing Address - Fax:626-821-0406
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:626-397-5139
Practice Address - Fax:626-397-3409
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA637302085B0100X, 2085R0202X, 2085R0204X, 2085U0001X
CA00A6373002085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A637300Medicaid
CAWA6373Medicare ID - Type Unspecified
CAH37715Medicare UPIN