Basic Information
Provider Information | |||||||||
NPI: | 1720020894 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOH | ||||||||
FirstName: | YINCE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 25608 | ||||||||
Address2: |   | ||||||||
City: | SALT LAKE CITY | ||||||||
State: | UT | ||||||||
PostalCode: | 841250608 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2063204476 | ||||||||
FaxNumber: | 2065687043 | ||||||||
Practice Location | |||||||||
Address1: | 550 17TH AVE | ||||||||
Address2: | 5TH FLOOR | ||||||||
City: | SEATTLE | ||||||||
State: | WA | ||||||||
PostalCode: | 981225788 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2063202800 | ||||||||
FaxNumber: | 2063202827 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/12/2006 | ||||||||
LastUpdateDate: | 11/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/30/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | AFE92388 | CA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 311 | WI | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2086S0102X | AFE92388 | CA | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2085R0204X | MD60021578 | WA | Y |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 207T00000X | AFE92388 | CA | N |   | Allopathic & Osteopathic Physicians | Neurological Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 00A923880 | 05 | CA |   | MEDICAID |