Basic Information
| Provider Information | |||||||||
| NPI: | 1164696753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LI | ||||||||
| FirstName: | YAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 CHESHIRE LN N | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554463706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883339152 | ||||||||
| FaxNumber: | 7632684240 | ||||||||
| Practice Location | |||||||||
| Address1: | 416 W LAS TUNAS DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAN GABRIEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917761236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262819889 | ||||||||
| FaxNumber: | 6262810399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 07/24/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA 7283 | CA | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | AU2611 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.