Healthcare Provider Details

I. General information

NPI: 1114765351
Provider Name (Legal Business Name): YUNGNAN BEAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA OUTPATIENT CLINIC 201 9TH STREET
MARINA CA
93933
US

IV. Provider business mailing address

VA OUTPATIENT CLINIC 201 9TH STREET
MARINA CA
93933
US

V. Phone/Fax

Practice location:
  • Phone: 831-884-1166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number590217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: