| NPI |
1154960235 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Provider Last Name Legal Name |
AUYOUNG |
The last name of the provider. If the provider is an individual, this is the legal name. |
| Provider First Name |
WENDY |
The first name of the provider, if the provider
is an individual. |
| Provider First Line Business Practice Location Address |
385 ESPLANADE AVE |
The first name of the provider, if the provider
is an individual. |
| Provider Business Practice Location Address City Name |
PACIFICA |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
CA |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address Postal Code |
940441882 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Telephone Number |
6509935576 |
The telephone number associated with the location address of the provider being identified. |
| Provider Enumeration Date |
1/6/2020 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
9/19/2022 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
| Healthcare Provider Taxonomy Code 1 |
225100000X |
The code designating the provider’s gender if the provider is a person. |
| Provider License Number 1 |
297909 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 1 |
CA |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Is Sole Proprietor |
N |
|
| NPI Certification Date |
9/19/2022 |
|