Healthcare Provider Details

I. General information

NPI: 1144834615
Provider Name (Legal Business Name): GODWIN K YEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL PKWY
SAN JOSE CA
95119-1106
US

IV. Provider business mailing address

3678 SLATER CT
SAN JOSE CA
95132-1353
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-3315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number24549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: