Provider Demographics
NPI:1861267981
Name:YIN, JUSTIN SANGLY
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:SANGLY
Last Name:YIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11130 ANDERSON STREET
Mailing Address - Street 2:DEPARTMENT OF PSYCHOLOGY, SUITE 101
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350
Mailing Address - Country:US
Mailing Address - Phone:909-558-8706
Mailing Address - Fax:
Practice Address - Street 1:11130 ANDERSON STREET
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY, SUITE 101
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350
Practice Address - Country:US
Practice Address - Phone:909-558-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program