Healthcare Provider Details

I. General information

NPI: 1801251178
Provider Name (Legal Business Name): MISSION MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6334 MISSION BLVD
RIVERSIDE CA
92509-4123
US

IV. Provider business mailing address

6334 MISSION BLVD
RIVERSIDE CA
92509-4123
US

V. Phone/Fax

Practice location:
  • Phone: 951-248-9113
  • Fax:
Mailing address:
  • Phone: 951-248-9113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA38547
License Number StateCA

VIII. Authorized Official

Name: KEE I YANG
Title or Position: PROVIDER
Credential: M.D.
Phone: 951-248-9113