Healthcare Provider Details

I. General information

NPI: 1265336994
Provider Name (Legal Business Name): AARON J YI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 S BROOKHURST ST UNIT 104
ANAHEIM CA
92804-3510
US

IV. Provider business mailing address

631 S BROOKHURST ST UNIT 104
ANAHEIM CA
92804-3510
US

V. Phone/Fax

Practice location:
  • Phone: 714-620-8131
  • Fax: 714-620-8132
Mailing address:
  • Phone: 714-620-8131
  • Fax: 714-620-8132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-MXJBTG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: