Healthcare Provider Details

I. General information

NPI: 1316125198
Provider Name (Legal Business Name): HEIDI NINA YEUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # 8216
SAN DIEGO CA
92103-8216
US

IV. Provider business mailing address

14094 RUE SAINT RAPHAEL
DEL MAR CA
92014-3043
US

V. Phone/Fax

Practice location:
  • Phone: 619-471-3316
  • Fax:
Mailing address:
  • Phone: 650-644-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301090925
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA103222
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA103222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: