Provider Demographics
NPI:1508637588
Name:YU, KYLEN KAILEONG
Entity Type:Individual
Prefix:
First Name:KYLEN
Middle Name:KAILEONG
Last Name:YU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W RODELL PL
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-5149
Mailing Address - Country:US
Mailing Address - Phone:626-262-5083
Mailing Address - Fax:
Practice Address - Street 1:745 W NAOMI AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7517
Practice Address - Country:US
Practice Address - Phone:626-446-9261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH190812183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician