1306980859 NPI number — TRACEY Y YAN

Table of content: TRACEY Y YAN (NPI 1306980859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306980859 NPI number — TRACEY Y YAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAN
Provider First Name:
TRACEY
Provider Middle Name:
Y
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YAN
Provider Other First Name:
YEUNHUEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306980859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7402
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94537-7402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-490-9600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39833 PASEO PADRE PKWY STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-2980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-490-9600
Provider Business Practice Location Address Fax Number:
510-490-9601
Provider Enumeration Date:
02/17/2007

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: 106H00000X , with the licence number:  MFC43261 , 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: 01674804 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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