Healthcare Provider Details

I. General information

NPI: 1659663276
Provider Name (Legal Business Name): STEPHEN W YEUNG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST STE B-100
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

11370 ANDERSON ST
LOMA LINDA CA
92354-3450
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2880
  • Fax:
Mailing address:
  • Phone: 909-558-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number15069
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number125063356
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberUO3358
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: