Healthcare Provider Details

I. General information

NPI: 1801740576
Provider Name (Legal Business Name): ANDREW YAGHNAM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 SYCAMORE DR
SIMI VALLEY CA
93065-1201
US

IV. Provider business mailing address

2975 SYCAMORE DR
SIMI VALLEY CA
93065-1201
US

V. Phone/Fax

Practice location:
  • Phone: 805-955-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: