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General NPI Number Information
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NPI Number | 1497574727
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Entity Type | Organization
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Legal Business Name | YK PROFESSIONAL MEDICAL GROUP PC
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 5450 BEACH BLVD STE 100
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City | BUENA PARK
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State | CA
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Zip | 90621-1277
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Country | US
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Telephone | 714-752-6273
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Fax | 714-716-1948
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Provider Business Mailing Address
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Address Line | 5450 BEACH BLVD STE 100
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City | BUENA PARK
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State | CA
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Zip | 90621-1277
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Country | US
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Telephone | 714-752-6273
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Fax | 714-716-1948
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Authorized Official
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Title or Position | CEO
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Name | BERNARD TILMAN MCNAMARA
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Credential | MD
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Telephone | 310-480-4770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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