Healthcare Provider Details

I. General information

NPI: 1578643870
Provider Name (Legal Business Name): JOHN RAYMOND YUEN PHARM.D., BCNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1983 MARENGO ST RADIOPHARMACY - LAC/USC MEDICAL CENTER
LOS ANGELES CA
90033-1370
US

IV. Provider business mailing address

1983 MARENGO ST RADIOPHARMACY - LAC/USC MEDICAL CENTER
LOS ANGELES CA
90033-1370
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-7861
  • Fax:
Mailing address:
  • Phone: 323-409-7861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42142
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9900
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License Number42142
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number42142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: