Healthcare Provider Details

I. General information

NPI: 1548187123
Provider Name (Legal Business Name): YORKTOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 EASTBLUFF DR STE 105
NEWPORT BEACH CA
92660-3549
US

IV. Provider business mailing address

2503 EASTBLUFF DR STE 105
NEWPORT BEACH CA
92660-3549
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-8065
  • Fax:
Mailing address:
  • Phone: 949-760-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0505X
TaxonomyDiabetology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LI WEN
Title or Position: CEO
Credential: MD
Phone: 949-413-9017