Provider Demographics
NPI:1912045022
Name:SNYDER, ANGELINA YOON (PA)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:YOON
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 MIDVALE AVE
Mailing Address - Street 2:#302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4815
Mailing Address - Country:US
Mailing Address - Phone:310-477-6858
Mailing Address - Fax:
Practice Address - Street 1:1711 OCEAN PARK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-4901
Practice Address - Country:US
Practice Address - Phone:310-450-2191
Practice Address - Fax:310-450-0873
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17438363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 17438Medicaid