Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC24875 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC24875 | CA |
NPI | 1326070830 |
---|---|
Provider Name | Dr. Gilbert Youdeem |
First Address | Cypress, CA 90630-3827 |
Second Address | Cypress, CA 90630-3827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 05/10/2009 |