Healthcare Provider Details

I. General information

NPI: 1982970786
Provider Name (Legal Business Name): KATHERINE PHAN YEE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WINSTON ST
LOS ANGELES CA
90013-1519
US

IV. Provider business mailing address

311 WINSTON ST
LOS ANGELES CA
90013-1519
US

V. Phone/Fax

Practice location:
  • Phone: 213-893-1960
  • Fax: 855-332-6757
Mailing address:
  • Phone: 213-893-1960
  • Fax: 855-332-6757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number21963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: