Healthcare Provider Details

I. General information

NPI: 1831997543
Provider Name (Legal Business Name): YEW DREAM GOLF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S BEACH BLVD STE N
LA HABRA CA
90631-1107
US

IV. Provider business mailing address

1301 S BEACH BLVD STE N
LA HABRA CA
90631-1107
US

V. Phone/Fax

Practice location:
  • Phone: 562-448-0770
  • Fax:
Mailing address:
  • Phone: 562-448-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN OH
Title or Position: GENERAL MANAGER
Credential:
Phone: 562-448-0770