MEDICARE: MI YE NA YU FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95034943	CA

General Provider Information

NPI Number	:	1255122289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MI YE NA YU FNP

Provider Business Mailing Address
First Line	:	28241 CROWN VALLEY PKWY STE F312
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-4441
Country	:	US
Telephone Number	:	949-424-5613
Fax Number	:

Provider Business Practice Location Address
First Line	:	28241 CROWN VALLEY PKWY STE F312
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-4441
Country	:	US
Telephone Number	:	949-424-5613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2025
Last Update Date	:	02/20/2026

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