MEDICARE: DR. MALVIN YAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	20A7810	CA

General Provider Information

NPI Number	:	1033153101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALVIN YAN D.O.

Provider Business Mailing Address
First Line	:	9844 ATLANTIC AVE
Second Line	:	# B
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-5219
Country	:	US
Telephone Number	:	310-886-0869
Fax Number	:	310-886-0870

Provider Business Practice Location Address
First Line	:	9844 ATLANTIC AVE
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-5219
Country	:	US
Telephone Number	:	310-886-0869
Fax Number	:	310-886-0870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/30/2019

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