Provider Demographics
NPI:1184050452
Name:BACHYNSKY, YANA O
Entity type:Individual
Prefix:
First Name:YANA
Middle Name:O
Last Name:BACHYNSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YANA
Other - Middle Name:O
Other - Last Name:MUKVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3555 KENYON STREET
Mailing Address - Street 2:UNIT 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110
Mailing Address - Country:US
Mailing Address - Phone:619-600-0683
Mailing Address - Fax:
Practice Address - Street 1:3555 KENYON STREET
Practice Address - Street 2:UNIT 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-600-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA100107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)