MEDICARE: DR MALVIN YAN INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225146061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MALVIN YAN INC

Provider Business Mailing Address
First Line	:	16415 COLORADO AVE
Second Line	:	410
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-5035
Country	:	US
Telephone Number	:	323-562-3800
Fax Number	:	562-529-7600

Provider Business Practice Location Address
First Line	:	16415 SOUTH COLORADO AVE
Second Line	:	410
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-5035
Country	:	US
Telephone Number	:	323-562-3800
Fax Number	:	562-529-7600

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MALVIN YEN YAN
Credential	:	D.O.
Telephone Number	:	562-531-3800

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/12/2008

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Directions to “DR MALVIN YAN INC ” Practice Location

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