Provider Demographics
NPI:1659780567
Name:YAN, WENFEI
Entity Type:Individual
Prefix:
First Name:WENFEI
Middle Name:
Last Name:YAN
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 1:2064 POINSETTIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5849
Mailing Address - Country:US
Mailing Address - Phone:408-833-3029
Mailing Address - Fax:
Practice Address - Street 1:2011 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3404
Practice Address - Country:US
Practice Address - Phone:559-224-0920
Practice Address - Fax:559-225-0114
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist