Healthcare Provider Details

I. General information

NPI: 1114699527
Provider Name (Legal Business Name): CANDICE YAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 HAMPTON DR
VENICE CA
90291-8633
US

IV. Provider business mailing address

1119 1/2 4TH AVE
LOS ANGELES CA
90019-3428
US

V. Phone/Fax

Practice location:
  • Phone: 310-309-6001
  • Fax:
Mailing address:
  • Phone: 310-938-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC10745
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: