Healthcare Provider Details

I. General information

NPI: 1942950159
Provider Name (Legal Business Name): JOHN AHMAD YAMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 LAUREL ST
ANCHORAGE AK
99508-5333
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-6300
  • Fax: 907-729-5180
Mailing address:
  • Phone: 907-729-6801
  • Fax: 907-729-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number238593
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: