Amy Yetasook MD Incorporated

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

AMY YETASOOK MD INCORPORATED

Practice address

1386B W 7TH St
San Pedro, CA 90732-3517

Phone

(213) 268-5421

NPI assigned

Feb 6, 2023

Last updated

Feb 6, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Amy Yetasook, M.D.NPI 1982028130

Title

President

Phone

(213) 268-5421

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amy Kim Yetasook, M.D.

  • Surgery Physician
  • Urbana, IL
  • NPI 1982028130

  CA

  Medicare reassignment NPD Authorized official
• Malgorzata V Stanczyk, M.D.

  • Surgery Physician
  • Long Beach, CA
  • NPI 1104029859
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675641600000",
    "number": "1003512559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 OCEAN DR",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902663059",
            "telephone_number": "213-268-5421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1386B W 7TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323517",
            "telephone_number": "213-268-5421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMY YETASOOK MD INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-06",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A",
        "authorized_official_last_name": "YETASOOK",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-268-5421",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yvonne Alvarez
• Michael Amaya
• Priscilla S Amezquita
• Marcia Amponsah
• Amy L. Kennedy Chiropractic, Inc.
• Anchor Physical Therapy Apc
• Jeffrey Andersen
• Andrew C Sheng DMD Apc
• Mayra Angeles Hernandez
• Angel George Angelow, M.D.

• Surgery Physician in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.