1861418246 NPI number — DR. ELAINE YIN MD

Table of content: DR. ELAINE YIN MD (NPI 1861418246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861418246 NPI number — DR. ELAINE YIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YIN
Provider First Name:
ELAINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1861418246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 S PALISADE DR STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93454-8903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-354-7101
Provider Business Mailing Address Fax Number:
805-354-7102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 SOUTH PALISADE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454-8903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-354-7101
Provider Business Practice Location Address Fax Number:
805-354-7102
Provider Enumeration Date:
07/15/2006

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: 207V00000X , with the licence number:  G74466 , 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: 00G744660 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0092200 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB221953 . This is a "MEDICARE ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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