Healthcare Provider Details

I. General information

NPI: 1215062526
Provider Name (Legal Business Name): LISA YEUNG MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 S SUNSET AVE STE 200
WEST COVINA CA
91790-3940
US

IV. Provider business mailing address

420 W ROWLAND ST
COVINA CA
91723-2943
US

V. Phone/Fax

Practice location:
  • Phone: 626-732-8390
  • Fax:
Mailing address:
  • Phone: 626-331-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA17166
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: