Healthcare Provider Details

I. General information

NPI: 1538941463
Provider Name (Legal Business Name): SIAN E YONGYUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 90TH ST FL 3
DALY CITY CA
94015-1879
US

IV. Provider business mailing address

350 90TH ST FL 3
DALY CITY CA
94015-1879
US

V. Phone/Fax

Practice location:
  • Phone: 650-877-5700
  • Fax:
Mailing address:
  • Phone: 650-877-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: