Provider Demographics
NPI:1265864185
Name:GREG SHIH-HAN YEN MEDICAL CORP
Entity Type:Organization
Organization Name:GREG SHIH-HAN YEN MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:SHIH-HAN
Authorized Official - Last Name:YEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-576-8500
Mailing Address - Street 1:1522 S GARFIELD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5070
Mailing Address - Country:US
Mailing Address - Phone:626-576-8500
Mailing Address - Fax:626-576-8050
Practice Address - Street 1:1522 S GARFIELD AVE
Practice Address - Street 2:STE A
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5070
Practice Address - Country:US
Practice Address - Phone:626-576-8500
Practice Address - Fax:626-576-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61210207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A612100Medicaid
CA00A612100Medicaid