Healthcare Provider Details

I. General information

NPI: 1801374798
Provider Name (Legal Business Name): WAN YIN YEUNG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W VALLEY BLVD STE 100
SAN GABRIEL CA
91776-5716
US

IV. Provider business mailing address

3218 HONOLULU AVE APT 2
LA CRESCENTA CA
91214-3377
US

V. Phone/Fax

Practice location:
  • Phone: 626-308-3800
  • Fax: 626-308-1899
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95009565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: