Provider Demographics
NPI:1043510076
Name:KISSI, DAVID YAW (FNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:YAW
Last Name:KISSI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 TAHOE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3158
Mailing Address - Country:US
Mailing Address - Phone:909-434-4294
Mailing Address - Fax:
Practice Address - Street 1:1426 TAHOE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3158
Practice Address - Country:US
Practice Address - Phone:909-434-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily