Healthcare Provider Details

I. General information

NPI: 1205906435
Provider Name (Legal Business Name): TZE-SEUN YONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 WEIMER RD
TAOS NM
87571-6284
US

IV. Provider business mailing address

1397 WEIMER RD
TAOS NM
87571-6284
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-8883
  • Fax:
Mailing address:
  • Phone: 505-758-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2002-0164
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: