Provider Demographics
NPI:1629605613
Name:EDMINSTER, SARAH YURI SHIONOYA
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:YURI SHIONOYA
Last Name:EDMINSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:YURI SHIONOYA
Other - Last Name:APPLEGATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:CLINIC TOWER, SUITE A7D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:213-785-4186
Mailing Address - Fax:
Practice Address - Street 1:1200 N. STATE STREET
Practice Address - Street 2:CLINIC TOWER , SUITE A7D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:213-785-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program