Healthcare Provider Details

I. General information

NPI: 1558973081
Provider Name (Legal Business Name): HEATHER CHRISTIE YEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 ZONAL AVE
LOS ANGELES CA
90089-5305
US

IV. Provider business mailing address

754 CANYON WASH DR
PASADENA CA
91107-2061
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-1369
  • Fax:
Mailing address:
  • Phone: 575-219-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: