Healthcare Provider Details

I. General information

NPI: 1619610854
Provider Name (Legal Business Name): NANCE YUAN, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/15/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 ARDEN AVE STE 530
GLENDALE CA
91203-1140
US

IV. Provider business mailing address

PO BOX 50331
LOS ANGELES CA
90050-0203
US

V. Phone/Fax

Practice location:
  • Phone: 626-888-1202
  • Fax:
Mailing address:
  • Phone: 415-793-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NANCE YUAN
Title or Position: CEO
Credential: MD
Phone: 415-793-7368