Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4250 | CA |
Y | 222Z00000X | Podiatrist | E4250 | CA |
NPI | 1033120118 |
---|---|
Provider Name | Mr. Ki Sang Yi |
First Address | Long Beach, CA 90804-2124 |
Second Address | Long Beach, CA 90804-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 19/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E42500 | (05) | CA |
BY6684612 | DEA (01) | CA |
E4250A | PALMETTO GBA (01) | CA |
U78991 | (02) | CA |