Basic Information
Provider Information | |||||||||
NPI: | 1801061866 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YEH | ||||||||
FirstName: | JASON | ||||||||
MiddleName: | SAMUEL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 638336 | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452638336 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2813592229 | ||||||||
FaxNumber: | 2813592329 | ||||||||
Practice Location | |||||||||
Address1: | 350 KINGWOOD MEDICAL DR | ||||||||
Address2: | SUITE 210 | ||||||||
City: | KINGWOOD | ||||||||
State: | TX | ||||||||
PostalCode: | 773396405 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2813592229 | ||||||||
FaxNumber: | 2813592329 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/29/2008 | ||||||||
LastUpdateDate: | 11/12/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/12/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VE0102X | Q3132 | TX | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology | 207VE0102X | 2012-00790 | NC | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology |
No ID Information.