Provider Demographics
NPI:1578955712
Name:YI, HYUN JIN (PA-C)
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:JIN
Last Name:YI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:YI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:14761 SUNNY LAND AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-3141
Mailing Address - Country:US
Mailing Address - Phone:703-408-2723
Mailing Address - Fax:
Practice Address - Street 1:5005 N PIEDRAS ST.
Practice Address - Street 2:WILLIAM BEAUMONT ARMY MEDICAL CENTER (WBAMC)
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920
Practice Address - Country:US
Practice Address - Phone:703-408-2723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1125528363AM0700X
TXPA13494363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical