MEDICARE: RANDALL K. YEE MD, A PROFESSIONAL MEDICAL CORPORATION

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	A34506	CA

General Provider Information

NPI Number	:	1336324458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALL K. YEE MD, A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	165 SAINT DOMINICS DR
Second Line	:	STE. #201
City	:	MANTECA
State	:	CA
Zip	:	95337-7802
Country	:	US
Telephone Number	:	209-823-1701
Fax Number	:	209-823-0996

Provider Business Practice Location Address
First Line	:	165 SAINT DOMINICS DR
Second Line	:	STE. #201
City	:	MANTECA
State	:	CA
Zip	:	95337-7802
Country	:	US
Telephone Number	:	209-823-1701
Fax Number	:	209-823-0996

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	RANDALL K YEE
Credential	:	M.D.
Telephone Number	:	209-823-1701

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	02/20/2012

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