Healthcare Provider Details

I. General information

NPI: 1407402605
Provider Name (Legal Business Name): EVELYN YIP CHAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CAMPUS RD
LOS ANGELES CA
90041-3314
US

IV. Provider business mailing address

1600 CAMPUS RD
LOS ANGELES CA
90041-3314
US

V. Phone/Fax

Practice location:
  • Phone: 323-259-2657
  • Fax:
Mailing address:
  • Phone: 323-259-2657
  • Fax: 323-341-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013092
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number760547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: