Healthcare Provider Details

I. General information

NPI: 1962813345
Provider Name (Legal Business Name): JINSUN YI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 160
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1872 STOW ST
SIMI VALLEY CA
93063-4265
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-8476
  • Fax:
Mailing address:
  • Phone: 808-265-0973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: