=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225146061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR MALVIN YAN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 12/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16415 SOUTH COLORADO AVE 410
-----------------------------------------------------
City | PARAMOUNT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90723-5035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-562-3800
-----------------------------------------------------
Fax | 562-529-7600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16415 COLORADO AVE 410
-----------------------------------------------------
City | PARAMOUNT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90723-5035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-562-3800
-----------------------------------------------------
Fax | 562-529-7600
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MALVIN YEN YAN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 562-531-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 20A7810
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------