Basic Information
Provider Information | |||||||||
NPI: | 1548201148 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YEH | ||||||||
FirstName: | LLOYD | ||||||||
MiddleName: | RONG KUNG | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 24701 EUCLID AVE | ||||||||
Address2: |   | ||||||||
City: | EUCLID | ||||||||
State: | OH | ||||||||
PostalCode: | 441171714 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2164758844 | ||||||||
FaxNumber: | 2164753816 | ||||||||
Practice Location | |||||||||
Address1: | 13201 GRANGER RD STE 2 | ||||||||
Address2: |   | ||||||||
City: | GARFIELD HTS | ||||||||
State: | OH | ||||||||
PostalCode: | 441251979 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2164758844 | ||||||||
FaxNumber: | 2164753816 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/08/2006 | ||||||||
LastUpdateDate: | 07/28/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35075673 | OH | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 208000000X | 35-075673 | OH | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 000000526187 | 01 | OH | ANTHEM | OTHER | 364156 | 01 | OH | WELLCARE | OTHER | 5141724 | 01 | OH | AETNA | OTHER | 2134890 | 01 | OH | BCMH | OTHER | 000000221330 | 01 | OH | UNISON | OTHER | 2134890 | 05 | OH |   | MEDICAID | 732600 | 01 | OH | BUCKEYE | OTHER |