Healthcare Provider Details

I. General information

NPI: 1174071799
Provider Name (Legal Business Name): YEN LE PHAN MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 SANTA ANITA AVE
EL MONTE CA
91731-1606
US

IV. Provider business mailing address

1420 S 5TH ST APT D
ALHAMBRA CA
91803-3344
US

V. Phone/Fax

Practice location:
  • Phone: 626-919-5724
  • Fax:
Mailing address:
  • Phone: 626-320-3354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP029810
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: