MEDICARE: DR. GRACE S YEH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	J5954	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J5954	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1033193271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACE S YEH M.D.

Provider Business Mailing Address
First Line	:	3624 N HILLS DR
Second Line	:	B-102
City	:	AUSTIN
State	:	TX
Zip	:	78731-2415
Country	:	US
Telephone Number	:	512-343-8011
Fax Number	:	512-343-6462

Provider Business Practice Location Address
First Line	:	3624 N HILLS DR
Second Line	:	B-102
City	:	AUSTIN
State	:	TX
Zip	:	78731-2415
Country	:	US
Telephone Number	:	512-343-8011
Fax Number	:	512-343-6462

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	07/08/2007

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