Healthcare Provider Details

I. General information

NPI: 1376863381
Provider Name (Legal Business Name): PAUL YUM PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 ROOSEVELT AVE
REDWOOD CITY CA
94061-1304
US

IV. Provider business mailing address

2150 ROOSEVELT AVE
REDWOOD CITY CA
94061-1304
US

V. Phone/Fax

Practice location:
  • Phone: 650-369-2071
  • Fax:
Mailing address:
  • Phone: 650-369-2071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: