Provider Demographics
NPI:1962461368
Name:YUAN, JUN (MD)
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:
Last Name:YUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 FULLERTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3103
Mailing Address - Country:US
Mailing Address - Phone:951-808-8863
Mailing Address - Fax:951-808-0550
Practice Address - Street 1:1810 FULLERTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3103
Practice Address - Country:US
Practice Address - Phone:951-808-8863
Practice Address - Fax:951-808-0550
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA70186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH33001Medicare UPIN