Provider Demographics
NPI:1740660372
Name:YEO, KEVIN SOON LENG (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:SOON LENG
Last Name:YEO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 1ST ST BLDG 23
Mailing Address - Street 2:
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-8273
Mailing Address - Country:US
Mailing Address - Phone:575-572-2778
Mailing Address - Fax:575-572-3182
Practice Address - Street 1:280 1ST ST BLDG 23
Practice Address - Street 2:
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-8273
Practice Address - Country:US
Practice Address - Phone:575-572-2778
Practice Address - Fax:575-572-3182
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005497A171000000X, 208D00000X
IN261Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program