Provider Demographics
NPI:1619341245
Name:YIN, YIYI (PSYD)
Entity Type:Individual
Prefix:
First Name:YIYI
Middle Name:
Last Name:YIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KOOK
Other - Middle Name:
Other - Last Name:YIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2400 MOORPARK AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 MOORPARK AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2680
Practice Address - Country:US
Practice Address - Phone:415-701-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA33508103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program