Healthcare Provider Details

I. General information

NPI: 1740660372
Provider Name (Legal Business Name): KEVIN SOON LENG YEO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 1ST ST BLDG 23
HOLLOMAN AFB NM
88330-8273
US

IV. Provider business mailing address

280 1ST ST BLDG 23
HOLLOMAN AFB NM
88330-8273
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-2778
  • Fax: 575-572-3182
Mailing address:
  • Phone: 575-572-2778
  • Fax: 575-572-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number02005497A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02005497A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: