Provider Demographics
NPI:1790733673
Name:TASTO, JESSICA ANN YOONG (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN YOONG
Last Name:TASTO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:YOONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1642 7TH AVE
Mailing Address - Street 2:UNIT 428
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 WEST ARBOR DR MC 8201
Practice Address - Street 2:UCSD MEDICAL CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8201
Practice Address - Country:US
Practice Address - Phone:858-534-6290
Practice Address - Fax:619-543-3183
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12772152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0127720Medicaid
CAWOP12772AMedicare ID - Type Unspecified
V05075Medicare UPIN