Healthcare Provider Details

I. General information

NPI: 1902827892
Provider Name (Legal Business Name): EAST BAY PRIMARY CARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 9TH ST SUITE 403
OAKLAND CA
94607-6514
US

IV. Provider business mailing address

373 9TH ST SUITE 403
OAKLAND CA
94607-6514
US

V. Phone/Fax

Practice location:
  • Phone: 510-465-3588
  • Fax: 510-465-4369
Mailing address:
  • Phone: 510-465-3588
  • Fax: 510-465-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: YVONNE YEUNG
Title or Position: OFFICER
Credential: M.D.
Phone: 510-465-3588