Provider Demographics
NPI:1942473491
Name:CENTRAL COAST ONCOLOGY & HEMATOLOGY
Entity Type:Organization
Organization Name:CENTRAL COAST ONCOLOGY & HEMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-475-2220
Mailing Address - Street 1:1669 DOMINICAN WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1523
Mailing Address - Country:US
Mailing Address - Phone:831-475-2220
Mailing Address - Fax:831-475-2221
Practice Address - Street 1:1669 DOMINICAN WAY
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1523
Practice Address - Country:US
Practice Address - Phone:831-475-2220
Practice Address - Fax:831-475-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN