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General NPI Number Information
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NPI Number | 1477099257
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Entity Type | Individual
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Provider Name | SHIRLEY YAN OD
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Gender | Female
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 15051 HESPERIAN BLVD SUITE A
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City | SAN LEANDRO
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State | CA
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Zip | 94578-3536
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Country | US
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Telephone | 510-276-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 3191 CROW CANYON PL STE C
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City | SAN RAMON
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State | CA
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Zip | 94583-1349
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Country | US
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Telephone | 925-244-1400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT33620 TLG
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License Number State | CA
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