Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A109479 | CA |
Y | 2084N0402X | Child Neurologist | A109479 | CA |
NPI | 1295060440 |
---|---|
Provider Name | Yana Jane Tavyev |
First Address | Los Angeles, CA 90051-0717 |
Second Address | West Hollywood, CA 90048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2009 |
Last Update Date | 17/05/2018 |