Provider Demographics
NPI:1518605203
Name:JOHNSON, YASHA XU (RN)
Entity Type:Individual
Prefix:MS
First Name:YASHA
Middle Name:XU
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:YASHA
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 3RD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5795
Mailing Address - Country:US
Mailing Address - Phone:718-902-0549
Mailing Address - Fax:
Practice Address - Street 1:617 3RD AVE APT 4
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5795
Practice Address - Country:US
Practice Address - Phone:718-902-0549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95196388163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse