Provider Demographics
NPI:1316125198
Name:YEUNG, HEIDI NINA (MD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:NINA
Last Name:YEUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14094 RUE SAINT RAPHAEL
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3043
Mailing Address - Country:US
Mailing Address - Phone:650-644-8924
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR # 8216
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8216
Practice Address - Country:US
Practice Address - Phone:619-471-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090925207Q00000X
CAA103222207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P29690003Medicare PIN