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General NPI Number Information
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NPI Number | 1245315662
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Entity Type | Organization
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Legal Business Name | JENNY YAN YAM
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 1732 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90006-5804
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Country | US
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Telephone | 323-733-9390
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Fax | 323-766-8251
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Provider Business Mailing Address
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Address Line | 1732 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90006-5804
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Country | US
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Telephone | 323-733-9390
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Fax | 323-766-8251
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Authorized Official
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Title or Position | OWNER
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Name | MS. JENNY YAN YAM
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Credential | PHARM.D
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Telephone | 323-733-9390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY41098
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License Number State | CA
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