1225115892 NPI number — DR. ERIC YAN

Table of content: DR. ERIC YAN (NPI 1225115892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225115892 NPI number — DR. ERIC YAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAN
Provider First Name:
ERIC
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225115892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3660 PARK SIERRA DR
Provider Second Line Business Mailing Address:
STE 203
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92505-3071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-687-3400
Provider Business Mailing Address Fax Number:
951-687-7630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27851 BRADLEY RD
Provider Second Line Business Practice Location Address:
STE 125
Provider Business Practice Location Address City Name:
MENIFEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92586-2282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-672-7967
Provider Business Practice Location Address Fax Number:
951-246-3747
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  A84382 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BX068Y . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A843820 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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