Basic Information
Provider Information
NPI: 1750670774
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YUNG
FirstName: VICTORIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1450 TREAT BLVD
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945972168
CountryCode: US
TelephoneNumber: 9259522888
FaxNumber:  
Practice Location
Address1: 1479 YGNACIO VALLEY RD
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 94598
CountryCode: US
TelephoneNumber: 9252967340
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/30/2011
LastUpdateDate: 01/12/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/12/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100XA124473CAY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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