Healthcare Provider Details

I. General information

NPI: 1700283199
Provider Name (Legal Business Name): YDB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 04/15/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 VAN BUREN ST
EUGENE OR
97402-4623
US

IV. Provider business mailing address

690 VAN BUREN ST
EUGENE OR
97402-4623
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-9966
  • Fax:
Mailing address:
  • Phone: 541-228-9966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number201050073NP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: YENA KIM
Title or Position: PRINCIPAL OFFICER
Credential: FNP-BC
Phone: 541-731-0031