Provider Demographics
NPI:1104406537
Name:YEH, JACOB NOHEA
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:NOHEA
Last Name:YEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19750 S VERMONT AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1130
Mailing Address - Country:US
Mailing Address - Phone:714-873-2064
Mailing Address - Fax:
Practice Address - Street 1:19750 S VERMONT AVE STE 140
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1130
Practice Address - Country:US
Practice Address - Phone:714-873-2064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician