Provider Demographics
NPI:1942389242
Name:GORDON, YVETTE MC (MD)
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:MC
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:18600 S FIGUEROA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4505
Mailing Address - Country:US
Mailing Address - Phone:310-512-6755
Mailing Address - Fax:310-512-6725
Practice Address - Street 1:18600 S FIGUEROA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4505
Practice Address - Country:US
Practice Address - Phone:310-512-6755
Practice Address - Fax:310-512-6725
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2021-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY225566207Q00000X
NJMA074799207Q00000X
CAA65095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY225566OtherNYS LICENSE
NMMA0704799OtherNJ LICENSE
NY0356P1Medicare ID - Type Unspecified
NMMA0704799OtherNJ LICENSE