Healthcare Provider Details

I. General information

NPI: 1558283473
Provider Name (Legal Business Name): SAMUEL YI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 QUEENS PLZ N FL 5
LONG ISLAND CITY NY
11101-4172
US

IV. Provider business mailing address

8836 139TH ST APT 4A
JAMAICA NY
11435-4171
US

V. Phone/Fax

Practice location:
  • Phone: 718-391-8300
  • Fax:
Mailing address:
  • Phone: 347-804-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number901024
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: