Basic Information
| Provider Information | |||||||||
| NPI: | 1407366313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | YONUI | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3517 SELIGMAN DR. | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614968940 | ||||||||
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| Practice Location | |||||||||
| Address1: | 655 S CENTRAL VALLEY HWY | ||||||||
| Address2: | |||||||||
| City: | SHAFTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932632790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617469194 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2017 | ||||||||
| LastUpdateDate: | 10/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 233665 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
ID Information
| ID | Type | State | Issuer | Description | 233665 | 01 | CA | BOARD OF VOCATIONAL NURSING AND PSYCHIATRIC TECHNICIANS | OTHER |