Provider Demographics
NPI:1417260241
Name:DR. MALVIN YAN INC.
Entity Type:Organization
Organization Name:DR. MALVIN YAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-430-6151
Mailing Address - Street 1:3625 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3509
Mailing Address - Country:US
Mailing Address - Phone:310-886-0869
Mailing Address - Fax:310-886-0870
Practice Address - Street 1:3625 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3509
Practice Address - Country:US
Practice Address - Phone:310-886-0869
Practice Address - Fax:310-886-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7810261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center