Healthcare Provider Details

I. General information

NPI: 1235592478
Provider Name (Legal Business Name): JUSTIN LEE YANUCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date: 11/20/2024
Reactivation Date: 12/18/2024

III. Provider practice location address

9333 IMPERIAL HWY
DOWNEY CA
90242-2812
US

IV. Provider business mailing address

9333 IMPERIAL HWY
DOWNEY CA
90242-2812
US

V. Phone/Fax

Practice location:
  • Phone: 562-657-7116
  • Fax:
Mailing address:
  • Phone: 562-657-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA152948
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number278535
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA152948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: