MEDICARE: YH MEDICAL GROUP PC

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	207R00000X	Internal Medicine Physician
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1083365548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YH MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	868 HUNTLEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-5002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	868 HUNTLEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-5002
Country	:	US
Telephone Number	:	402-302-0023
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RONALD JACOBY
Credential	:	MD
Telephone Number	:	402-302-0023

Provider Enumeration Date	:	01/15/2022
Last Update Date	:	01/15/2022

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