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NPI Code Detail

MEDICARE: JEAN R. YAN M.A.

MEDICARE: JEAN R. YAN M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist76646CA

General Provider Information

NPI Number : 1689063976
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN R. YAN M.A.
Provider Business Mailing Address
First Line : 1492 LAS POSADAS DR
Second Line :
City : DUARTE
State : CA
Zip : 91010-3863
Country : US
Telephone Number : 626-757-8430
Fax Number :
Provider Business Practice Location Address
First Line : 1492 LAS POSADAS DR
Second Line :
City : DUARTE
State : CA
Zip : 91010-3863
Country : US
Telephone Number : 626-757-8430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2015
Last Update Date : 01/09/2015

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