Provider Demographics
NPI:1831463744
Name:LIN, YAN (PHAM)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:PHAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 OLYMPIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1406
Mailing Address - Country:US
Mailing Address - Phone:626-444-0879
Mailing Address - Fax:
Practice Address - Street 1:14101 FRANCISQUITO AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-6145
Practice Address - Country:US
Practice Address - Phone:626-814-9342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist