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NPI Code Detail

MEDICARE: SANG MIN YI AGACNP

MEDICARE: SANG MIN YI AGACNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner95038165CA

General Provider Information

NPI Number : 1184567513
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANG MIN YI AGACNP
Provider Business Mailing Address
First Line : 4620 PENNSYLVANIA AVE
Second Line :
City : LA CRESCENTA
State : CA
Zip : 91214-2652
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 W HUNTINGTON DR
Second Line :
City : ARCADIA
State : CA
Zip : 91007-3402
Country : US
Telephone Number : 626-898-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2026
Last Update Date : 04/10/2026

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