Healthcare Provider Details

I. General information

NPI: 1609550813
Provider Name (Legal Business Name): YEMA MENYONGA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

520 SW 9TH ST UNIT 213
DES MOINES IA
50309-1267
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-5008
  • Fax:
Mailing address:
  • Phone: 754-244-5877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-12868
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: