Healthcare Provider Details

I. General information

NPI: 1528486578
Provider Name (Legal Business Name): EMILY YI CHUN YEH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2014
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST
TACOMA WA
98405-4933
US

IV. Provider business mailing address

3911 N 25TH ST APT 221
TACOMA WA
98406-5318
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-4101
  • Fax:
Mailing address:
  • Phone: 817-908-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR2505
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60894481
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: