Provider Demographics
NPI:1669581393
Name:YONG AT HEART TOTAL WELLNESS MEDICAL CORPORATION
Entity type:Organization
Organization Name:YONG AT HEART TOTAL WELLNESS MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:MEIJI
Authorized Official - Last Name:YONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-989-1892
Mailing Address - Street 1:16628 OAK VIEW CT
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1900
Mailing Address - Country:US
Mailing Address - Phone:310-989-1892
Mailing Address - Fax:818-789-0208
Practice Address - Street 1:16838 CLARK ST STE C
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1066
Practice Address - Country:US
Practice Address - Phone:818-789-0203
Practice Address - Fax:818-789-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61406261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11431045OtherCAQH ID NUMBER
CA00A614060OtherBLUE SHIELD PROVIDER ID #
CA0007134338OtherAETNA PROVIDER ID NUMBER
CA5596075OtherCCN/FIRST HEALTH PROVIDER
CAZZ66803ZOtherBLUE SHIELD
CAH01954Medicare UPIN
CAW18890Medicare ID - Type UnspecifiedGROUP ID NUMBER