Healthcare Provider Details

I. General information

NPI: 1164685194
Provider Name (Legal Business Name): BRIAN R YAP O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 COLORADO BLVD STE 239
LOS ANGELES CA
90041-1048
US

IV. Provider business mailing address

3354 THORNDALE RD
PASADENA CA
91107-4636
US

V. Phone/Fax

Practice location:
  • Phone: 323-258-2020
  • Fax: 888-769-4820
Mailing address:
  • Phone: 323-605-2063
  • Fax: 888-769-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13481
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number007498
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number001797
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: