Provider Demographics
NPI:1619971439
Name:VERMA, YASH P (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:YASH
Middle Name:P
Last Name:VERMA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 WHITSON ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3609
Mailing Address - Country:US
Mailing Address - Phone:559-896-1414
Mailing Address - Fax:559-896-5082
Practice Address - Street 1:1850 WHITSON ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3609
Practice Address - Country:US
Practice Address - Phone:559-896-1414
Practice Address - Fax:559-896-5082
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2008-01-29
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
CAC39061207Q00000X, 208D00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C390611Medicaid
CA553802Medicare Oscar/Certification
00C390611Medicare PIN