1336324458 NPI number — RANDALL K. YEE MD, A PROFESSIONAL MEDICAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336324458 NPI number — RANDALL K. YEE MD, A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDALL K. YEE MD, A PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336324458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 SAINT DOMINICS DR
Provider Second Line Business Mailing Address:
STE. #201
Provider Business Mailing Address City Name:
MANTECA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95337-7802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-823-1701
Provider Business Mailing Address Fax Number:
209-823-0996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 SAINT DOMINICS DR
Provider Second Line Business Practice Location Address:
STE. #201
Provider Business Practice Location Address City Name:
MANTECA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95337-7802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-823-1701
Provider Business Practice Location Address Fax Number:
209-823-0996
Provider Enumeration Date:
01/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
YEE
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
209-823-1701

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A34506 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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