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NPI Code Detail

MEDICARE: YEMISRACH A. BEYENE M.D.

MEDICARE: YEMISRACH A. BEYENE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianC168678CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1YB080711OTHERCHAMPUS-CHAMPUS
2080H262390OTHERBLUE CROSS-BLUE CROSS
3YB080711OTHERCOMMERCIAL-COMMERCIAL NUMBER
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528114980
Entity Type Code : Individual
Provider Name (Legal Business Name) : YEMISRACH A. BEYENE M.D.
Provider Business Mailing Address
First Line : 4921 DEHESA RD
Second Line :
City : EL CAJON
State : CA
Zip : 92019-2929
Country : US
Telephone Number : 619-445-0707
Fax Number : 619-445-0901
Provider Business Practice Location Address
First Line : 4921 DEHESA RD
Second Line :
City : EL CAJON
State : CA
Zip : 92019-2929
Country : US
Telephone Number : 619-445-0707
Fax Number : 619-445-0901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 02/03/2026

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