Provider Demographics
NPI:1700943131
Name:NORTHERN CALIF CHILDRENS HEMATOLOGY & ONCOLOGY MED GRP INC
Entity Type:Organization
Organization Name:NORTHERN CALIF CHILDRENS HEMATOLOGY & ONCOLOGY MED GRP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:YIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-469-9337
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368
Mailing Address - Country:US
Mailing Address - Phone:209-577-9900
Mailing Address - Fax:209-577-1509
Practice Address - Street 1:5030 J STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:906-469-9337
Practice Address - Fax:209-577-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0062830Medicaid