Provider Demographics
NPI:1255431219
Name:PACIFIC SLEEP LABS, INC.
Entity type:Organization
Organization Name:PACIFIC SLEEP LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YEAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-366-2701
Mailing Address - Street 1:161 AVENIDA VAQUERO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3601
Mailing Address - Country:US
Mailing Address - Phone:949-366-2701
Mailing Address - Fax:949-429-6918
Practice Address - Street 1:161 AVENIDA VAQUERO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3601
Practice Address - Country:US
Practice Address - Phone:949-366-2701
Practice Address - Fax:949-429-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG075362261QS1200X
CA261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG252Medicare ID - Type Unspecified
CATG252Medicare PIN