Provider Demographics
NPI:1699716084
Name:YEH, THOMAS JUI-TING (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JUI-TING
Last Name:YEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-7188
Mailing Address - Fax:912-354-5208
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-7188
Practice Address - Fax:912-354-5208
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010460208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG10460Medicaid
GAP00372928OtherRR MEDICARE
GA967264OtherBLUE CROSS BLUE SHIELD
582162071066OtherCHAMPUS
GA967264OtherBLUE CROSS BLUE SHIELD
GAP00372928OtherRR MEDICARE