Provider Demographics
NPI:1295036721
Name:TIMOTHY GUAN-TYNG YEH M D INC
Entity type:Organization
Organization Name:TIMOTHY GUAN-TYNG YEH M D INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:YEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-956-4958
Mailing Address - Street 1:2620 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4212
Mailing Address - Country:US
Mailing Address - Phone:949-378-2882
Mailing Address - Fax:714-400-0488
Practice Address - Street 1:1751 W ROMNEYA DR
Practice Address - Street 2:SUITE NUMBER A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1815
Practice Address - Country:US
Practice Address - Phone:714-956-4958
Practice Address - Fax:714-400-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81650305R00000X
305R00000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH11016Medicare UPIN
CAG81650Medicare PIN