Provider Demographics
NPI:1497574727
Name:YK PROFESSIONAL MEDICAL GROUP PC
Entity type:Organization
Organization Name:YK PROFESSIONAL MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:TILMAN
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-480-4770
Mailing Address - Street 1:5450 BEACH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1277
Mailing Address - Country:US
Mailing Address - Phone:714-752-6273
Mailing Address - Fax:714-716-1948
Practice Address - Street 1:5450 BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1277
Practice Address - Country:US
Practice Address - Phone:714-752-6273
Practice Address - Fax:714-716-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95008390OtherCALIFORNIA BOARD OF REGISTERED NURSING
CA95021251OtherCALIFORNIA BOARD OF REGISTERED NURSING