Provider Demographics
NPI:1720044415
Name:YEH, DAVID J (MMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:YEH
Suffix:
Gender:M
Credentials:MMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 HIGUERA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2917
Mailing Address - Country:US
Mailing Address - Phone:805-704-0889
Mailing Address - Fax:805-548-1994
Practice Address - Street 1:1531 HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2917
Practice Address - Country:US
Practice Address - Phone:805-704-0889
Practice Address - Fax:805-548-1994
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40688207T00000X
TXR5058207T00000X
MS20326207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05780015Medicaid
TNTN01X7OtherJOHN DEERE
MS7865604OtherAETNA
MSP00691498OtherRAILROAD MEDICARE
LA1466468Medicaid
TN4115908OtherBCBS
LA1466468Medicaid
MS7865604OtherAETNA
MS512I40017Medicare PIN