Healthcare Provider Details

I. General information

NPI: 1396373072
Provider Name (Legal Business Name): JUSTIN YEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 EASTLAKE AVENUE NORRIS TOPPING TOWER 3RD FLOOR, NTT 3440
LOS ANGELES CA
90033
US

IV. Provider business mailing address

631 PROFESSIONAL DR STE 450
LAWRENCEVILLE GA
30046-3370
US

V. Phone/Fax

Practice location:
  • Phone: 323-865-3823
  • Fax:
Mailing address:
  • Phone: 770-963-8030
  • Fax: 770-339-9577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number111163
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number186553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: