# THE PERMANENTE MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962864785
- **Authorized official:** DR. TIMOTHY YEN PSY.D. (PSYCHOLOGIST)
- **Authorized official phone:** (707) 645-2314

## Contact information

- **Practice address:** 1761 BROADWAY ST, SUITE 100, VALLEJO, CA 94589-2226
- **Practice address phone:** (707) 645-2700
- **Mailing address:** 1761 BROADWAY ST, SUITE 100, VALLEJO, CA 94589-2226
- **Mailing address phone:** (707) 645-2700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | PSY27745 | CA | Yes |

## Other

- **Enumeration date:** 03/22/2016
- **Last updated:** 03/22/2016