Provider Demographics
NPI:1992032122
Name:SHORECLIFFS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SHORECLIFFS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YEAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-489-8783
Mailing Address - Street 1:161 AVENIDA VAQUERO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3601
Mailing Address - Country:US
Mailing Address - Phone:949-489-8783
Mailing Address - Fax:949-493-9888
Practice Address - Street 1:161 AVENIDA VAQUERO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3601
Practice Address - Country:US
Practice Address - Phone:949-489-8783
Practice Address - Fax:949-493-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty