1790733673 NPI number — DR. JESSICA ANN YOONG TASTO O.D.

Table of content: DR. JESSICA ANN YOONG TASTO O.D. (NPI 1790733673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790733673 NPI number — DR. JESSICA ANN YOONG TASTO O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TASTO
Provider First Name:
JESSICA
Provider Middle Name:
ANN YOONG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOONG
Provider Other First Name:
JESSICA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790733673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1642 7TH AVE
Provider Second Line Business Mailing Address:
UNIT 428
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92101-2722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 WEST ARBOR DR MC 8201
Provider Second Line Business Practice Location Address:
UCSD MEDICAL CENTER
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-8201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-534-6290
Provider Business Practice Location Address Fax Number:
619-543-3183
Provider Enumeration Date:
05/04/2006

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: 152W00000X , with the licence number:  OPT12772 , 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)

  • Identifier: SD0127720 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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