Healthcare Provider Details

I. General information

NPI: 1992902662
Provider Name (Legal Business Name): JERRY YUAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL BREMERTON ONE BOONE RD
BREMERTON WA
98312
US

IV. Provider business mailing address

NAVAL HOSPITAL BREMERTON ONE BOONE RD
BREMERTON WA
98312
US

V. Phone/Fax

Practice location:
  • Phone: 360-475-5115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOP70075807
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0102206282
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: