Provider Demographics
NPI:1689985236
Name:YAMSUAN, GINA P
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:P
Last Name:YAMSUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2296 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5315
Mailing Address - Country:US
Mailing Address - Phone:510-608-3733
Mailing Address - Fax:510-797-7205
Practice Address - Street 1:2296 COUNTRY DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5315
Practice Address - Country:US
Practice Address - Phone:510-608-3733
Practice Address - Fax:510-797-7205
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0079820174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist