Healthcare Provider Details

I. General information

NPI: 1730183708
Provider Name (Legal Business Name): ALOYSIUS YINUG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 265TH ST NW
STANWOOD WA
98292-6221
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 360-629-1504
  • Fax: 360-629-1513
Mailing address:
  • Phone: 360-629-1504
  • Fax: 360-629-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00041402
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: