Healthcare Provider Details

I. General information

NPI: 1992465900
Provider Name (Legal Business Name): JACQUES RONG SEN YEOH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 W 8TH ST
SAN PEDRO CA
90731-3119
US

IV. Provider business mailing address

819 N 1ST ST APT B
ALHAMBRA CA
91801-1361
US

V. Phone/Fax

Practice location:
  • Phone: 310-834-1198
  • Fax:
Mailing address:
  • Phone: 424-527-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: