Provider Demographics
NPI:1740473198
Name:YOKOTA, SANDY THAI (PA-C)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:THAI
Last Name:YOKOTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 W ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2340
Mailing Address - Country:US
Mailing Address - Phone:909-394-2506
Mailing Address - Fax:
Practice Address - Street 1:1255 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2340
Practice Address - Country:US
Practice Address - Phone:909-394-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19227363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740473198Medicaid
CA1740473198Medicaid
CA1740473198Medicare NSC
CA1740473198Medicare PIN
CA1740473198Medicare Oscar/Certification