Provider Demographics
NPI:1194296004
Name:YEO, MEI YEN JADE GLORY
Entity type:Individual
Prefix:
First Name:MEI YEN
Middle Name:JADE GLORY
Last Name:YEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 W ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-5256
Mailing Address - Country:US
Mailing Address - Phone:310-918-3369
Mailing Address - Fax:
Practice Address - Street 1:1931 W ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-5256
Practice Address - Country:US
Practice Address - Phone:310-918-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT18799225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist