Basic Information
| Provider Information | |||||||||
| NPI: | 1669192225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YI | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | YOUNG | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1098 DEL CAMBRE DR | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951293212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082500325 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 HOSPITAL PKWY | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951191103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089723000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2022 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 852636 | CA | N | Nursing Service Providers | Registered Nurse | 367500000X | 95001863 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.