Healthcare Provider Details

I. General information

NPI: 1679892582
Provider Name (Legal Business Name): WAI-TAK ANNIE YEUNG P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S GARFIELD AVE SUITE 304
ALHAMBRA CA
91801-5859
US

IV. Provider business mailing address

707 S GARFIELD AVE SUITE 304
ALHAMBRA CA
91801-5859
US

V. Phone/Fax

Practice location:
  • Phone: 626-588-2825
  • Fax: 626-588-2850
Mailing address:
  • Phone: 626-588-2825
  • Fax: 626-588-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: