1942610464 NPI number — MR. YAROON GEBRESILASSIE KOCHITO FNP

Table of content: MR. YAROON GEBRESILASSIE KOCHITO FNP (NPI 1942610464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942610464 NPI number — MR. YAROON GEBRESILASSIE KOCHITO FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOCHITO
Provider First Name:
YAROON
Provider Middle Name:
GEBRESILASSIE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEBRESILASSIE
Provider Other First Name:
ASCHALEW
Provider Other Middle Name:
KOCHITO
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942610464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1999 MOWRY AVE STE ABDFN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94538-1738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-770-8040
Provider Business Mailing Address Fax Number:
916-515-8319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1999 MOWRY AVE STE ABDFN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-1738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-770-8040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  791125 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 95001599 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)