Provider Demographics
NPI:1114739505
Name:JINANYAN, SYUZANNA (NP)
Entity type:Individual
Prefix:
First Name:SYUZANNA
Middle Name:
Last Name:JINANYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 JUSTIN AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3613
Mailing Address - Country:US
Mailing Address - Phone:818-404-2292
Mailing Address - Fax:
Practice Address - Street 1:662 W BROADWAY STE C
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1008
Practice Address - Country:US
Practice Address - Phone:818-664-4112
Practice Address - Fax:818-671-0105
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95252771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily