Healthcare Provider Details

I. General information

NPI: 1447464375
Provider Name (Legal Business Name): ERIC YEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 SKYPARK DR STE 200
TORRANCE CA
90505-4749
US

IV. Provider business mailing address

3701 SKYPARK DR STE 200
TORRANCE CA
90505-4749
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA98436
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberA98436
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberA98436
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberA98436
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA98436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: