Healthcare Provider Details

I. General information

NPI: 1205817947
Provider Name (Legal Business Name): YU-YONG TAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 VIKING DR
JASPER AL
35501-6154
US

IV. Provider business mailing address

2401 VIKING DRIVE
JASPER AL
35501
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-5714
  • Fax: 205-221-5445
Mailing address:
  • Phone: 205-221-5714
  • Fax: 205-221-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number8722
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: