Provider Demographics
NPI:1659355907
Name:YUSIM, JEFFREY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:YUSIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 EAST VISTA WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5252
Mailing Address - Country:US
Mailing Address - Phone:760-295-7677
Mailing Address - Fax:760-295-7690
Practice Address - Street 1:950 EAST VISTA WAY
Practice Address - Street 2:SUITE C
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5252
Practice Address - Country:US
Practice Address - Phone:760-295-7677
Practice Address - Fax:760-295-7690
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2012-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA45129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11117Medicare UPIN