Healthcare Provider Details

I. General information

NPI: 1669304564
Provider Name (Legal Business Name): KINYANA YOUNETTE MCROY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6342 HOMEWOOD AVE
BUENA PARK CA
90621-2956
US

IV. Provider business mailing address

6342 HOMEWOOD AVE
BUENA PARK CA
90621-2956
US

V. Phone/Fax

Practice location:
  • Phone: 562-638-3548
  • Fax:
Mailing address:
  • Phone: 562-638-3548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95419235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: