Provider Demographics
NPI:1386825966
Name:MING-YI YEN M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MING-YI YEN M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MING-YI
Authorized Official - Middle Name:
Authorized Official - Last Name:YEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-633-2512
Mailing Address - Street 1:16415 COLORADO AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5035
Mailing Address - Country:US
Mailing Address - Phone:562-633-2512
Mailing Address - Fax:562-633-0300
Practice Address - Street 1:16415 COLORADO AVE
Practice Address - Street 2:STE 301
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5035
Practice Address - Country:US
Practice Address - Phone:562-633-2512
Practice Address - Fax:562-633-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-24
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35926207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A359260Medicaid
CA00A359260Medicaid
CAA84833Medicare UPIN