=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902117666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YEH FACIAL PLASTIC SURGERY, A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2010
-----------------------------------------------------
Last Update Date | 06/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24331 EL TORO RD SUITE 350
-----------------------------------------------------
City | LAGUNA WOODS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92637-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-916-7066
-----------------------------------------------------
Fax | 949-916-7067
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24331 EL TORO RD SUITE 350
-----------------------------------------------------
City | LAGUNA WOODS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92637-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-916-7066
-----------------------------------------------------
Fax | 949-916-7067
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CORY CHI-HONG YEH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 949-916-7066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | A106777
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------