Provider Demographics
NPI:1336324458
Name:RANDALL K. YEE MD, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:RANDALL K. YEE MD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-823-1701
Mailing Address - Street 1:165 SAINT DOMINICS DR
Mailing Address - Street 2:STE. #201
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7802
Mailing Address - Country:US
Mailing Address - Phone:209-823-1701
Mailing Address - Fax:209-823-0996
Practice Address - Street 1:165 SAINT DOMINICS DR
Practice Address - Street 2:STE. #201
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7802
Practice Address - Country:US
Practice Address - Phone:209-823-1701
Practice Address - Fax:209-823-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A345061Medicare PIN
CAA27497Medicare UPIN