Provider Demographics
NPI:1790924520
Name:YAM, VUTHY
Entity Type:Individual
Prefix:MR
First Name:VUTHY
Middle Name:
Last Name:YAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N MAIN ST STE 100B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3630
Mailing Address - Country:US
Mailing Address - Phone:714-480-6650
Mailing Address - Fax:714-571-5659
Practice Address - Street 1:1200 N MAIN ST STE 100B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3630
Practice Address - Country:US
Practice Address - Phone:714-480-6650
Practice Address - Fax:714-571-5659
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker