Provider Demographics
NPI:1902827892
Name:EAST BAY PRIMARY CARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:EAST BAY PRIMARY CARE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-465-3588
Mailing Address - Street 1:373 9TH ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6514
Mailing Address - Country:US
Mailing Address - Phone:510-465-3588
Mailing Address - Fax:510-465-4369
Practice Address - Street 1:373 9TH ST
Practice Address - Street 2:SUITE 403
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6514
Practice Address - Country:US
Practice Address - Phone:510-465-3588
Practice Address - Fax:510-465-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X, 207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0086140Medicaid
CAGR0086140Medicaid