MEDICARE: JENNY YAN YAM

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	3336C0003X	Community/Retail Pharmacy	PHY41098	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	:	1245315662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNY YAN YAM

Provider Business Mailing Address
First Line	:	1732 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5804
Country	:	US
Telephone Number	:	323-733-9390
Fax Number	:	323-766-8251

Provider Business Practice Location Address
First Line	:	1732 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5804
Country	:	US
Telephone Number	:	323-733-9390
Fax Number	:	323-766-8251

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JENNY YAN YAM
Credential	:	PHARM.D
Telephone Number	:	323-733-9390

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/24/2008

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