Healthcare Provider Details

I. General information

NPI: 1063861169
Provider Name (Legal Business Name): EVA YEE WAH YOUNG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVA YEE WAH WONG D.O.

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

1515 NEWELL AVE
WALNUT CREEK CA
94596-5120
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-3582
  • Fax: 210-702-4207
Mailing address:
  • Phone: 925-295-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A19039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: