Provider Demographics
NPI:1659631067
Name:YUAN, XIAOJUAN (PHARMD, BCPP, APH)
Entity Type:Individual
Prefix:DR
First Name:XIAOJUAN
Middle Name:
Last Name:YUAN
Suffix:
Gender:F
Credentials:PHARMD, BCPP, APH
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:YUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1161 E COVINA BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1523
Mailing Address - Country:US
Mailing Address - Phone:510-789-8038
Mailing Address - Fax:
Practice Address - Street 1:1161 E COVINA BLVD
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1523
Practice Address - Country:US
Practice Address - Phone:626-589-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630411835G0303X, 1835P1200X, 1835P1300X
CA100911835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatricGroup - Single Specialty