Healthcare Provider Details

I. General information

NPI: 1346002029
Provider Name (Legal Business Name): DORIS YEUNG M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 SIERRA VILLAGE WAY
SAN JOSE CA
95132-2773
US

IV. Provider business mailing address

1207 SIERRA VILLAGE WAY
SAN JOSE CA
95132-2773
US

V. Phone/Fax

Practice location:
  • Phone: 408-598-7568
  • Fax:
Mailing address:
  • Phone: 408-598-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number28020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: