Healthcare Provider Details

I. General information

NPI: 1780146266
Provider Name (Legal Business Name): OMAR YAMAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 418
LONG BEACH CA
90806-2794
US

IV. Provider business mailing address

PO BOX 3637
SEAL BEACH CA
90740-7637
US

V. Phone/Fax

Practice location:
  • Phone: 562-684-8096
  • Fax:
Mailing address:
  • Phone: 562-684-8096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA194848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: