Provider Demographics
NPI:1740252147
Name:YIN, LEOPOLD K (MD)
Entity type:Individual
Prefix:
First Name:LEOPOLD
Middle Name:K
Last Name:YIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 E BASELINE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4412
Mailing Address - Country:US
Mailing Address - Phone:480-273-8680
Mailing Address - Fax:480-306-7683
Practice Address - Street 1:4140 E BASELINE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4412
Practice Address - Country:US
Practice Address - Phone:480-273-8680
Practice Address - Fax:480-306-7683
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36985207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2560938Medicaid
H85640Medicare UPIN
OH2560938Medicaid