Healthcare Provider Details

I. General information

NPI: 1831463744
Provider Name (Legal Business Name): YAN LIN PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 FRANCISQUITO AVE
BALDWIN PARK CA
91706-6145
US

IV. Provider business mailing address

3003 OLYMPIC VIEW DR
CHINO HILLS CA
91709-1406
US

V. Phone/Fax

Practice location:
  • Phone: 626-814-9342
  • Fax:
Mailing address:
  • Phone: 626-444-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: