=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457591315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADRIAN YI MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2009
-----------------------------------------------------
Last Update Date | 03/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16311 VENTURA BLVD STE 550
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-4314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-986-7900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16311 VENTURA BLVD STE 550
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-4314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-986-7900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | STEFANIE BARRIOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-986-7900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G076079
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------