Provider Demographics
NPI:1659687226
Name:YELLOW CROSS MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:YELLOW CROSS MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:TAI
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-731-0681
Mailing Address - Street 1:3544 W. OLYMPIC BLVD. STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3500
Mailing Address - Country:US
Mailing Address - Phone:323-731-0681
Mailing Address - Fax:323-731-0832
Practice Address - Street 1:903 CRENSHAW BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1967
Practice Address - Country:US
Practice Address - Phone:323-731-0681
Practice Address - Fax:323-731-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67974261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659687226Medicaid
CA1659687226Medicaid