Healthcare Provider Details

I. General information

NPI: 1144132614
Provider Name (Legal Business Name): HYEONJEONG YU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 ROCKCRESS LN
BANNING CA
92220-1298
US

IV. Provider business mailing address

1331 ROCKCRESS LN
BANNING CA
92220-1298
US

V. Phone/Fax

Practice location:
  • Phone: 909-513-5471
  • Fax:
Mailing address:
  • Phone: 909-513-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95302987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: