Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A120403 | CA |
NPI | 1043442379 |
---|---|
Provider Name | Henry Yuan |
First Address | San Diego, CA 92123-2684 |
Second Address | Orange, CA 92869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 23/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A120403 | CA LICENSE (01) | CA |
CA128112 | NO CA MEDICARE PTAN (01) | CA |
CB219111 | SO CA MEDICARE PTAN (01) | CA |