Healthcare Provider Details

I. General information

NPI: 1689316382
Provider Name (Legal Business Name): YE TIAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S ATLANTIC BLVD STE 100
MONTEREY PARK CA
91754-3845
US

IV. Provider business mailing address

6411 COUNTRYWOOD PL
RANCHO CUCAMONGA CA
91739-9113
US

V. Phone/Fax

Practice location:
  • Phone: 626-300-9980
  • Fax:
Mailing address:
  • Phone: 626-327-4688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: