1508440967 NPI number — DR. TIMIIYE DAWN YOMI MBBS, MD

Table of content: DR. TIMIIYE DAWN YOMI MBBS, MD (NPI 1508440967)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508440967 NPI number — DR. TIMIIYE DAWN YOMI MBBS, MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
YOMI

Provider First Name:
TIMIIYE

Provider Middle Name:
DAWN

Provider Name Prefix Text:
DR.

Provider Name Suffix Text:

Provider Credential Text:
MBBS, MD

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
SUNWENGHAN

Provider Other First Name:
TIMIIYE

Provider Other Middle Name:
DAWN

Provider Other Name Prefix Text:
DR.

Provider Other Name Suffix Text:

Provider Other Credential Text:
MBBS, MD

Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508440967

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
10/21/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 W CENTRAL PARK AVE STE 4100

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
DAVENPORT

Provider Business Mailing Address State Name:
IA

Provider Business Mailing Address Postal Code:
52804-1847

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
563-421-2641

Provider Business Mailing Address Fax Number:
563-441-0544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EAST NILES COMMUNITY HEALTH CENTER

Provider Second Line Business Practice Location Address:
7800 NILES ST

Provider Business Practice Location Address City Name:
BAKERSFIELD

Provider Business Practice Location Address State Name:
CA

Provider Business Practice Location Address Postal Code:
93306

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
661-328-4284

Provider Business Practice Location Address Fax Number:
661-616-9977

Provider Enumeration Date:
05/11/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 207Q00000X , with the licence number: MD-53414 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 208M00000X , with the licence number: MD-53414 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .