Healthcare Provider Details

I. General information

NPI: 1003287517
Provider Name (Legal Business Name): ALLANDALE YAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR STE 230
GLENDALE CA
91205-4436
US

IV. Provider business mailing address

801 S CHEVY CHASE DR STE 230
GLENDALE CA
91205-4436
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-5587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: