Healthcare Provider Details

I. General information

NPI: 1083917439
Provider Name (Legal Business Name): YAW O ASAMOAH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 CAMELBACK LN
FONTANA CA
92336-5830
US

IV. Provider business mailing address

PO BOX 4570
PALOS VERDES PENINSULA CA
90274-9607
US

V. Phone/Fax

Practice location:
  • Phone: 213-804-9776
  • Fax:
Mailing address:
  • Phone: 424-400-7748
  • Fax: 424-400-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20953
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: