Healthcare Provider Details

I. General information

NPI: 1487233003
Provider Name (Legal Business Name): TIM YANNI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ANAHEIM BLVD STE 101
ANAHEIM CA
92805-3848
US

IV. Provider business mailing address

100 S ANAHEIM BLVD STE 101
ANAHEIM CA
92805-3848
US

V. Phone/Fax

Practice location:
  • Phone: 714-826-1200
  • Fax: 714-665-4652
Mailing address:
  • Phone: 714-826-1200
  • Fax: 714-665-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A20467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: