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General NPI Number Information
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NPI Number | 1003512559
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Entity Type | Organization
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Legal Business Name | AMY YETASOOK MD INCORPORATED
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 1386B W 7TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-3517
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Country | US
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Telephone | 213-268-5421
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Fax |
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Provider Business Mailing Address
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Address Line | 4220 OCEAN DR
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-3059
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Country | US
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Telephone | 213-268-5421
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMY YETASOOK
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Credential | M.D.
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Telephone | 213-268-5421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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