Provider Demographics
NPI:1073591491
Name:YEN, LILI YUNCHIEN (PA-C)
Entity Type:Individual
Prefix:
First Name:LILI
Middle Name:YUNCHIEN
Last Name:YEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 VETERAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3135
Mailing Address - Country:US
Mailing Address - Phone:512-743-6180
Mailing Address - Fax:
Practice Address - Street 1:4955 VAN NUYS BLVD STE 502
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1817
Practice Address - Country:US
Practice Address - Phone:818-325-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX PA 03352363A00000X
CAPA 15786363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant