NPIMap

Organization Active NPI

Yong at Heart Total Wellness Medical Corporation

  • Clinic/Center
  • Encino, CA
National Provider Identifier
1669581393
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
A61406 Issued in CA
Legal business name
YONG AT HEART TOTAL WELLNESS MEDICAL CORPORATION
Practice address
16838 Clark St Ste C
Encino, CA 91436-1066
Phone
(818) 789-0203
Fax
(818) 789-0208
NPI assigned
Aug 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Authorized official

Name
Dr. Marjorie Meiji Yong, M.D.NPI 1417062167
Title
President
Phone
(310) 989-1892

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X A61406 CA Primary

Addresses

Primary practice location

16838 Clark St Ste C
Encino, CA 91436-1066

Mailing address

16628 Oak View CT
Encino, CA 91436-1900
Phone (310) 989-1892

Other identifiers 5

IdentifierTypeStateIssuer
11431045OtherCACAQH ID NUMBER
00A614060OtherCABLUE SHIELD PROVIDER ID #
0007134338OtherCAAETNA PROVIDER ID NUMBER
5596075OtherCACCN/FIRST HEALTH PROVIDER
ZZ66803ZOtherCABLUE SHIELD

Other names 1

  • Yong at Heart Total Wellness Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050607001354 CA Part B Supplier - Clinic/Group Practice 8921041211 Receives reassigned benefits from 1 practitioner
Practice locations: Encino, CA

National Provider Directory

National Provider Directory

Locations

5400 Balboa Blvd
#212A
Encino, CA 91316

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646956800000",
    "number": "1669581393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16628 OAK VIEW CT",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914361900",
            "telephone_number": "310-989-1892",
            "fax_number": "818-789-0208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16838 CLARK ST STE C",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914361066",
            "telephone_number": "818-789-0203",
            "fax_number": "818-789-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YONG AT HEART TOTAL WELLNESS MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A",
        "authorized_official_last_name": "YONG",
        "authorized_official_first_name": "MARJORIE",
        "authorized_official_middle_name": "MEIJI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-989-1892",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A61406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID NUMBER",
            "identifier": "11431045",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER ID #",
            "identifier": "00A614060",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER ID NUMBER",
            "identifier": "0007134338",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN/FIRST HEALTH PROVIDER",
            "identifier": "5596075",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZ66803Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yong at Heart Total Wellness",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Yong at Heart Total Wellness",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.