Provider Demographics
NPI:1306867718
Name:YE, RUILIAN (LMT)
Entity Type:Individual
Prefix:
First Name:RUILIAN
Middle Name:
Last Name:YE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21744 YBARRA RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4327
Mailing Address - Country:US
Mailing Address - Phone:818-288-4220
Mailing Address - Fax:818-771-0994
Practice Address - Street 1:4890 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4229
Practice Address - Country:US
Practice Address - Phone:818-288-4220
Practice Address - Fax:818-771-0994
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002133973-0001-7171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO751065OtherABMP IN-DUES LIABILITY PR