Healthcare Provider Details

I. General information

NPI: 1457102055
Provider Name (Legal Business Name): REGINA YIM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 03/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 E 120TH ST
LOS ANGELES CA
90059-3026
US

IV. Provider business mailing address

3140 SAN MARINO ST UNIT 301
LOS ANGELES CA
90006-1475
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-8000
  • Fax:
Mailing address:
  • Phone: 626-622-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH84114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: