Provider Demographics
NPI:1225146061
Name:DR MALVIN YAN INC
Entity Type:Organization
Organization Name:DR MALVIN YAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALVIN
Authorized Official - Middle Name:YEN
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-531-3800
Mailing Address - Street 1:16415 COLORADO AVE
Mailing Address - Street 2:410
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5035
Mailing Address - Country:US
Mailing Address - Phone:323-562-3800
Mailing Address - Fax:562-529-7600
Practice Address - Street 1:16415 SOUTH COLORADO AVE
Practice Address - Street 2:410
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5035
Practice Address - Country:US
Practice Address - Phone:323-562-3800
Practice Address - Fax:562-529-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7810207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225146061Medicaid
CA1225146061Medicaid
CAW20082Medicare PIN