Individual provider Active NPI

Tisha Kamneodsuphaphol Yeh, M.D.

  • Pediatrics Physician
  • Sacramento, CA
National Provider Identifier
1073764668
Registry record updated Jan 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A102013 Issued in CA
Practice address
2315 Stockton Blvd
UC Davis Medical Center - Department of Pediatrics
Sacramento, CA 95817-2201
Phone
(916) 734-2011
NPI assigned
Oct 1, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A102013 CA Primary
Pediatrics Physician 208000000X 4301095384 MI

Addresses

Primary practice location

2315 Stockton Blvd
UC Davis Medical Center - Department of Pediatrics
Sacramento, CA 95817-2201

Mailing address

2315 Stockton Blvd
UC Davis Medical Center - Department of Pediatrics
Sacramento, CA 95817-2201
Phone (916) 734-2011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140506000098 CA Practitioner - Pediatric Medicine 6204962103 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A102013CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca CurrentSince Jan 1, 2014 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the University of Ca Pediatrics CurrentSince Jan 1, 2014 Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

2315 Stockton Blvd
#5
Sacramento, CA 95817
Phone (916) 703-3050

2315 Stockton Blvd
Sacramento, CA 95817
Phone (916) 703-3030

2521 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-1104

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388707200000",
    "number": "1073764668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 STOCKTON BLVD",
            "address_2": "UC DAVIS MEDICAL CENTER - DEPARTMENT OF PEDIATRICS",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172201",
            "telephone_number": "916-734-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 STOCKTON BLVD",
            "address_2": "UC DAVIS MEDICAL CENTER - DEPARTMENT OF PEDIATRICS",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172201",
            "telephone_number": "916-734-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YEH",
        "first_name": "TISHA",
        "middle_name": "KAMNEODSUPHAPHOL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-01",
        "last_updated": "2014-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A102013",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301095384",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.