Healthcare Provider Details

I. General information

NPI: 1578819751
Provider Name (Legal Business Name): Y & Y MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 S WESTERN AVE STE 201
LOS ANGELES CA
90006-1015
US

IV. Provider business mailing address

966 S WESTERN AVE STE 201
LOS ANGELES CA
90006-1015
US

V. Phone/Fax

Practice location:
  • Phone: 323-452-0656
  • Fax: 562-443-3791
Mailing address:
  • Phone: 323-452-0656
  • Fax: 562-443-3791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA112040
License Number StateCA

VIII. Authorized Official

Name: HO JE LEE
Title or Position: PRESIDENT
Credential:
Phone: 818-484-7592