MEDICARE: DR. JOHN KOFI AGYARE YEBOAH MD

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
1	207R00000X	Internal Medicine Physician	A102409	CA

General Provider Information

NPI Number	:	1578714978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN KOFI AGYARE YEBOAH MD

Provider Business Mailing Address
First Line	:	5850 OCEAN TERRACE DR
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90275-5759
Country	:	US
Telephone Number	:	310-755-8414
Fax Number	:

Provider Business Practice Location Address
First Line	:	5850 OCEAN TERRACE DR
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90275-5759
Country	:	US
Telephone Number	:	310-755-8414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	12/06/2021

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