Healthcare Provider Details

I. General information

NPI: 1699610808
Provider Name (Legal Business Name): REZIKA MOHAMMED YESUF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 15TH ST
HUNTINGTON WV
25701-3662
US

IV. Provider business mailing address

923 11TH ST
HUNTINGTON WV
25701-3318
US

V. Phone/Fax

Practice location:
  • Phone: 208-401-6004
  • Fax:
Mailing address:
  • Phone: 408-991-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2502
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: