Provider Demographics
NPI:1679892582
Name:YEUNG, WAI-TAK ANNIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:WAI-TAK ANNIE
Middle Name:
Last Name:YEUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S GARFIELD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5859
Mailing Address - Country:US
Mailing Address - Phone:626-588-2825
Mailing Address - Fax:626-588-2850
Practice Address - Street 1:707 S GARFIELD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5859
Practice Address - Country:US
Practice Address - Phone:626-588-2825
Practice Address - Fax:626-588-2850
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20019363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant