Organization
YONG AT HEART TOTAL WELLNESS MEDICAL CORPORATION
Active
Organization
YONG AT HEART TOTAL WELLNESS MEDICAL CORPORATION
Active
Other names
Yong at Heart Total Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARJORIE MEIJI YONG M.D. (PRESIDENT)
(310) 989-1892
Entity
Organization
Contact information
Practice address
16838 CLARK ST STE C, ENCINO, CA 91436-1066
(818) 789-0203
(818) 789-0208
Mailing address
16628 OAK VIEW CT, ENCINO, CA 91436-1900
(310) 989-1892
(818) 789-0208
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A61406
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007134338
AETNA PROVIDER ID NUMBER
CA
01
—
00A614060
BLUE SHIELD PROVIDER ID #
CA
01
—
11431045
CAQH ID NUMBER
CA
01
—
5596075
CCN/FIRST HEALTH PROVIDER
CA
01
—
ZZ66803Z
BLUE SHIELD
CA
Enumeration date
08/29/2006
Last updated
03/11/2022
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