Healthcare Provider Details

I. General information

NPI: 1831105055
Provider Name (Legal Business Name): KING-WAH W YEUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 FAIRCHILD CT
WOODLAND CA
95695
US

IV. Provider business mailing address

329 ENCINA AVE
DAVIS CA
95616
US

V. Phone/Fax

Practice location:
  • Phone: 530-666-1631
  • Fax: 530-668-2697
Mailing address:
  • Phone: 530-750-3467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA85572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: