Healthcare Provider Details

I. General information

NPI: 1750918579
Provider Name (Legal Business Name): EDWIN YAU LCSW, MPA, PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N BROADWAY
LOS ANGELES CA
90031-2856
US

IV. Provider business mailing address

300 W VALLEY BLVD # E84
ALHAMBRA CA
91803-3338
US

V. Phone/Fax

Practice location:
  • Phone: 323-207-0213
  • Fax:
Mailing address:
  • Phone: 310-256-6398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number93635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: