Basic Information
| Provider Information | |||||||||
| NPI: | 1043442379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YUAN | ||||||||
| FirstName: | HENRY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9610 GRANITE RIDGE DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588108000 | ||||||||
| FaxNumber: | 8582681911 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 E CHAPMAN AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147718000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2009 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | A120403 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | A120403 | 01 | CA | CA LICENSE | OTHER | CB219111 | 01 | CA | SO CA MEDICARE PTAN | OTHER | CA128112 | 01 | CA | NO CA MEDICARE PTAN | OTHER |