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General NPI Number Information
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NPI Number | 1932203478
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Entity Type | Individual
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Provider Name | JAN R PENVOSE-YI MD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 3998 VISTA WAY STE C
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City | OCEANSIDE
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State | CA
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Zip | 92056-4514
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Country | US
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Telephone | 760-385-8008
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Fax | 760-385-8007
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Provider Business Mailing Address
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Address Line | 3998 VISTA WAY STE C
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City | OCEANSIDE
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State | CA
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Zip | 92056-4514
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Country | US
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Telephone | 760-385-8008
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Fax | 760-385-8007
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | P132992
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 238705
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License Number State | NY
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