Basic Information
Provider Information
NPI: 1578798161
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YEAN
FirstName: NAY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1975 LONG BEACH BLVD FL 2
Address2:  
City: LONG BEACH
State: CA
PostalCode: 908065501
CountryCode: US
TelephoneNumber: 5625999401
FaxNumber: 5622180402
Practice Location
Address1: 1975 LONG BEACH BLVD FL 2
Address2:  
City: LONG BEACH
State: CA
PostalCode: 908065501
CountryCode: US
TelephoneNumber: 5625999401
FaxNumber: 5622180402
Other Information
ProviderEnumerationDate: 05/26/2009
LastUpdateDate: 05/26/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X  Y Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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