Healthcare Provider Details

I. General information

NPI: 1184636268
Provider Name (Legal Business Name): JAN YUO, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 HONOLULU AVE STE 128
MONTROSE CA
91020-1800
US

IV. Provider business mailing address

2490 HONOLULU AVE STE 128
MONTROSE CA
91020-1800
US

V. Phone/Fax

Practice location:
  • Phone: 818-330-9960
  • Fax: 818-330-9963
Mailing address:
  • Phone: 818-330-9960
  • Fax: 818-330-9963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA37730
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA37730
License Number StateCA

VIII. Authorized Official

Name: DR. JAN JENG YUO
Title or Position: OWNER
Credential: M.D.
Phone: 818-330-9960