Healthcare Provider Details

I. General information

NPI: 1174128482
Provider Name (Legal Business Name): LEON YAN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29995 TECHNOLOGY DR STE 100
MURRIETA CA
92563-2632
US

IV. Provider business mailing address

29995 TECHNOLOGY DR STE 100
MURRIETA CA
92563-2632
US

V. Phone/Fax

Practice location:
  • Phone: 951-412-1610
  • Fax:
Mailing address:
  • Phone: 951-412-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEON YAN
Title or Position: MD/OWNER
Credential: MD
Phone: 951-412-1610