Healthcare Provider Details

I. General information

NPI: 1912214214
Provider Name (Legal Business Name): CAROLINE YONG, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 OCEAN AVE #104
SAN FRANCISCO CA
94132
US

IV. Provider business mailing address

2645 OCEAN AVE #104
SAN FRANCISCO CA
94132
US

V. Phone/Fax

Practice location:
  • Phone: 415-587-8932
  • Fax: 415-587-8379
Mailing address:
  • Phone: 415-587-8932
  • Fax: 415-587-8379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG063994
License Number StateCA

VIII. Authorized Official

Name: CAROLINE YONG
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 415-587-8932