Healthcare Provider Details

I. General information

NPI: 1225146061
Provider Name (Legal Business Name): DR MALVIN YAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16415 SOUTH COLORADO AVE 410
PARAMOUNT CA
90723-5035
US

IV. Provider business mailing address

16415 COLORADO AVE 410
PARAMOUNT CA
90723-5035
US

V. Phone/Fax

Practice location:
  • Phone: 323-562-3800
  • Fax: 562-529-7600
Mailing address:
  • Phone: 323-562-3800
  • Fax: 562-529-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20A7810
License Number StateCA

VIII. Authorized Official

Name: DR. MALVIN YEN YAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 562-531-3800