Provider Demographics
NPI:1235664764
Name:YAN, WAI (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:WAI
Middle Name:
Last Name:YAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E. PLAZA BLVD
Mailing Address - Street 2:SUITE L
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5162
Mailing Address - Country:US
Mailing Address - Phone:619-267-0768
Mailing Address - Fax:619-267-1197
Practice Address - Street 1:2220 E. PLAZA BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-5162
Practice Address - Country:US
Practice Address - Phone:619-267-0768
Practice Address - Fax:619-267-1197
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist