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NPI Code Detail

MEDICARE: DR. KYONG MIN YI M.D.

MEDICARE: DR. KYONG MIN YI 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
1208600000XSurgery PhysicianMD189845OR
2208600000XSurgery Physician18168NV
3208600000XSurgery PhysicianG85233CA

General Provider Information

NPI Number : 1306846399
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYONG MIN YI M.D.
Provider Business Mailing Address
First Line : PO BOX 3379
Second Line :
City : TRUCKEE
State : CA
Zip : 96160-3379
Country : US
Telephone Number : 408-228-2357
Fax Number : 408-993-8555
Provider Business Practice Location Address
First Line : 1460 G ST
Second Line :
City : SPRINGFIELD
State : OR
Zip : 97477-4112
Country : US
Telephone Number : 541-726-4406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2005
Last Update Date : 05/09/2019

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