Provider Demographics
NPI:1699574616
Name:GEBREKIDAN, YEWOUBDAR
Entity type:Individual
Prefix:
First Name:YEWOUBDAR
Middle Name:
Last Name:GEBREKIDAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13102 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2418
Mailing Address - Country:US
Mailing Address - Phone:972-672-2022
Mailing Address - Fax:
Practice Address - Street 1:13102 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2418
Practice Address - Country:US
Practice Address - Phone:972-672-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care