Provider Demographics
NPI:1275245037
Name:YI, JIN-A (AG-ACNP-BC)
Entity Type:Individual
Prefix:
First Name:JIN-A
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9623 W MONTE LINDO
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4340
Mailing Address - Country:US
Mailing Address - Phone:602-334-0362
Mailing Address - Fax:
Practice Address - Street 1:3131 E CLARENDON AVE STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7069
Practice Address - Country:US
Practice Address - Phone:602-253-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ285242363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care