Healthcare Provider Details

I. General information

NPI: 1346341344
Provider Name (Legal Business Name): INCHEL YEAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31001 RANCHO VIEJO RD SUITE 200
SAN JUAN CAPISTRANO CA
92675-8704
US

IV. Provider business mailing address

17360 BROOKHURST ST ATTN: MCMF - CREDENTIALING DEPT.
FOUNTAIN VALLEY CA
92708-3720
US

V. Phone/Fax

Practice location:
  • Phone: 949-661-9600
  • Fax: 949-443-6200
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG075362
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG075362
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG075362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: