Healthcare Provider Details

I. General information

NPI: 1184796229
Provider Name (Legal Business Name): SARA T YEUNG RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 W. 17TH ST ALTAMED
SANTA ANA CA
92706-3455
US

IV. Provider business mailing address

724 BARNUM WAY
MONTEREY PARK CA
91754-2425
US

V. Phone/Fax

Practice location:
  • Phone: 714-502-0192
  • Fax:
Mailing address:
  • Phone: 626-278-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number814702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: