Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | G60214 | CA |
NPI | 1114941598 |
---|---|
Provider Name | Steven T Yedlin |
First Address | Oakland, CA 94618-1845 |
Second Address | Oakland, CA 94609-3210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 02/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B48831 | (02) | CA |