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General NPI Number Information
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NPI Number | 1447948864
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Entity Type | Organization
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Legal Business Name | MARINA YAM MD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 825 POLLARD RD STE 109
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City | LOS GATOS
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State | CA
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Zip | 95032-1435
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Country | US
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Telephone | 408-376-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 17608 VINELAND CT
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City | MONTE SERENO
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State | CA
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Zip | 95030-3226
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Country | US
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Telephone | 408-455-2959
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARINA YAM
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Credential | MD
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Telephone | 408-455-2959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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