Provider Demographics
NPI:1790980662
Name:YUBA CITY INTERNAL MEDICINE GROUP
Entity Type:Organization
Organization Name:YUBA CITY INTERNAL MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YASH
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-674-2434
Mailing Address - Street 1:481 PLUMAS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-5075
Mailing Address - Country:US
Mailing Address - Phone:530-674-2434
Mailing Address - Fax:530-674-2704
Practice Address - Street 1:481 PLUMAS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5075
Practice Address - Country:US
Practice Address - Phone:530-674-2434
Practice Address - Fax:530-674-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05550ZMedicare PIN