Healthcare Provider Details

I. General information

NPI: 1265361075
Provider Name (Legal Business Name): ERIC T. YEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 W PICO BLVD
LOS ANGELES CA
90019-3835
US

IV. Provider business mailing address

1626 1/2 S. LA BREA AVENUE
LOS ANGELES(999)-999-9999 EXTENSIONEXTE CA
90019
US

V. Phone/Fax

Practice location:
  • Phone: 323-528-7066
  • Fax:
Mailing address:
  • Phone: 323-528-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number160141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: