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General NPI Number Information
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NPI Number | 1942610464
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Entity Type | Individual
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Provider Name | YAROON GEBRESILASSIE KOCHITO FNP
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Gender | Male
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 1999 MOWRY AVE STE ABDFN
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City | FREMONT
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State | CA
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Zip | 94538-1738
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Country | US
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Telephone | 510-770-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 1999 MOWRY AVE STE ABDFN
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City | FREMONT
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State | CA
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Zip | 94538-1738
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Country | US
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Telephone | 510-770-8040
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Fax | 916-515-8319
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 791125
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95001599
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License Number State | CA
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