Healthcare Provider Details

I. General information

NPI: 1568010106
Provider Name (Legal Business Name): MR. PETER YUEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 RAMONA BLVD STE A
IRWINDALE CA
91706-3752
US

IV. Provider business mailing address

815 COLORADO BLVD STE 300
LOS ANGELES CA
90041-1744
US

V. Phone/Fax

Practice location:
  • Phone: 626-373-2900
  • Fax:
Mailing address:
  • Phone: 323-542-2800
  • Fax: 323-978-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number90232
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number90232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: