Provider Demographics
NPI:1760409742
Name:YOUKER, SUMMER R
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:R
Last Name:YOUKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 J ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4307
Mailing Address - Country:US
Mailing Address - Phone:916-492-1828
Mailing Address - Fax:916-492-1834
Practice Address - Street 1:2805 J ST STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4307
Practice Address - Country:US
Practice Address - Phone:916-492-1828
Practice Address - Fax:916-492-1834
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53335207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760409742Medicaid
CAH56127Medicare UPIN