Provider Demographics
NPI:1609413665
Name:ZLATIN, YAN
Entity Type:Individual
Prefix:MR
First Name:YAN
Middle Name:
Last Name:ZLATIN
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 1:15270 SUTTON ST APT 206
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3931
Mailing Address - Country:US
Mailing Address - Phone:818-324-7193
Mailing Address - Fax:818-276-0009
Practice Address - Street 1:21001 SHERMAN WAY # 14A
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1760
Practice Address - Country:US
Practice Address - Phone:747-230-0424
Practice Address - Fax:818-276-0009
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLD1035156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician