Individual provider Active NPI

Yoo Min Yoon

  • Physician Assistant
  • Oakland, CA
National Provider Identifier
1053176701
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
64259 Issued in CA
Practice address
450 30TH St
Oakland, CA 94609-3302
Phone
(510) 869-9200
NPI assigned
Feb 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 64259 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

450 30TH St
Oakland, CA 94609-3302

Mailing address

3231 Mary Ann St
La Crescenta, CA 91214-2641

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240823002237 CA Practitioner - Physician Assistant 2769921634 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince Jul 24, 2024 Accepting new patients

Locations

751 Medical Center Ct
#1182
Chula Vista, CA 91911

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1708387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1053176701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 MARY ANN ST",
            "city": "LA CRESCENTA",
            "state": "CA",
            "postal_code": "912142641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 30TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093302",
            "telephone_number": "510-869-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOON",
        "first_name": "YOO MIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-20",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "64259",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.