Healthcare Provider Details

I. General information

NPI: 1942046149
Provider Name (Legal Business Name): ANDIA YEKAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA ST STE 201
SAN FRANCISCO CA
94110-4420
US

IV. Provider business mailing address

1580 VALENCIA ST STE 201
SAN FRANCISCO CA
94110-4420
US

V. Phone/Fax

Practice location:
  • Phone: 415-550-0811
  • Fax: 415-550-0877
Mailing address:
  • Phone: 415-550-0811
  • Fax: 415-550-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA65789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: