Healthcare Provider Details

I. General information

NPI: 1316852189
Provider Name (Legal Business Name): YAE RIN HANCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN HANCOCK

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12919 S MANHATTAN PL
GARDENA CA
90249-1904
US

IV. Provider business mailing address

12919 S MANHATTAN PL
GARDENA CA
90249-1904
US

V. Phone/Fax

Practice location:
  • Phone: 818-437-6205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: