Healthcare Provider Details

I. General information

NPI: 1427366251
Provider Name (Legal Business Name): ZHENGHONG YUAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E LAS TUNAS DR STE 201
SAN GABRIEL CA
91776-1502
US

IV. Provider business mailing address

360 E LAS TUNAS DR STE 201
SAN GABRIEL CA
91776-1502
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-9978
  • Fax: 626-289-3978
Mailing address:
  • Phone: 626-289-9978
  • Fax: 626-289-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberA111673
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA111673
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License NumberA111673
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberA111673
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA111673
License Number StateCA

VIII. Authorized Official

Name: ZHENGHONG YUAN
Title or Position: PRESIDENT
Credential:
Phone: 626-289-9978