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NPI Code Detail

MEDICARE: GUAM DERMATOLOGY INSTITUTE LLC

MEDICARE: GUAM DERMATOLOGY INSTITUTE LLC
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
1207N00000XDermatology Physician

General Provider Information

NPI Number : 1306404413
Entity Type Code : Organization
Provider Name (Legal Business Name) : GUAM DERMATOLOGY INSTITUTE LLC
Provider Business Mailing Address
First Line : 633 GOV CARLOS G CAMACHO RD STE 102
Second Line :
City : TAMUNING
State : GU
Zip : 96913-3143
Country : US
Telephone Number : 671-588-5001
Fax Number : 671-649-5003
Provider Business Practice Location Address
First Line : 633 GOV CARLOS G CAMACHO RD STE 102
Second Line :
City : TAMUNING
State : GU
Zip : 96913-3143
Country : US
Telephone Number : 671-588-5001
Fax Number : 671-649-5003
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. HOSEONG YANG
Credential : MD PHD
Telephone Number : 671-588-5001
Provider Enumeration Date : 06/04/2019
Last Update Date : 10/11/2019

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Directions to “GUAM DERMATOLOGY INSTITUTE LLC ” Practice Location

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