MEDICARE: DR. YOHANNES ASSEFA DO

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	20A16760	CA

General Provider Information

NPI Number	:	1033635107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOHANNES ASSEFA DO

Provider Business Mailing Address
First Line	:	PO BOX 1088
Second Line	:
City	:	ARTESIA
State	:	CA
Zip	:	90702-1088
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3628 E IMPERIAL HWY STE 202
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2600
Country	:	US
Telephone Number	:	310-900-5010
Fax Number	:

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

Provider Enumeration Date	:	08/20/2017
Last Update Date	:	10/27/2023

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