Healthcare Provider Details

I. General information

NPI: 1275289670
Provider Name (Legal Business Name): ANDREW ALEXKEN FOOKPO YEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ALHAMBRA BLVD STE 300
SACRAMENTO CA
95816-5241
US

IV. Provider business mailing address

1201 ALHAMBRA BLVD STE 300
SACRAMENTO CA
95816-5241
US

V. Phone/Fax

Practice location:
  • Phone: 916-731-7866
  • Fax:
Mailing address:
  • Phone: 916-731-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA199007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: