Provider Demographics
NPI:1760465710
Name:YEE, RANDALL KELVIN (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:KELVIN
Last Name:YEE
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 1:600 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4201
Mailing Address - Country:US
Mailing Address - Phone:209-521-6097
Mailing Address - Fax:
Practice Address - Street 1:165 SAINT DOMINICS DR
Practice Address - Street 2:SUITE #201
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7802
Practice Address - Country:US
Practice Address - Phone:209-823-2345
Practice Address - Fax:209-823-1408
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A345061Medicare ID - Type Unspecified