Provider Demographics
NPI:1689720781
Name:SUBHERWAL, YASH P (MD)
Entity Type:Individual
Prefix:
First Name:YASH
Middle Name:P
Last Name:SUBHERWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12780 HESPERIA RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5806
Mailing Address - Country:US
Mailing Address - Phone:760-241-2270
Mailing Address - Fax:
Practice Address - Street 1:12780 HESPERIA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5806
Practice Address - Country:US
Practice Address - Phone:760-241-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A537840Medicaid
CA110207562OtherRAILROAD
CA00A537840Medicare ID - Type Unspecified
CA00A537840Medicaid