Healthcare Provider Details

I. General information

NPI: 1851589196
Provider Name (Legal Business Name): NICOLE YI, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9080 COLIMA RD
WHITTIER CA
90605-1600
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 562-945-3561
  • Fax:
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC51001
License Number StateCA

VIII. Authorized Official

Name: DR. NICOLE YI
Title or Position: PRESIDENT
Credential: MD
Phone: 800-883-7243