Healthcare Provider Details

I. General information

NPI: 1548708555
Provider Name (Legal Business Name): YONGBIN IM PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7655 CLAIREMONT MESA BLVD STE 306
SAN DIEGO CA
92111-1517
US

IV. Provider business mailing address

11656 CHESTERWOOD PL
SAN DIEGO CA
92130-8667
US

V. Phone/Fax

Practice location:
  • Phone: 858-268-1660
  • Fax:
Mailing address:
  • Phone: 619-876-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number36270
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number36270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: