Provider Demographics
NPI:1487935409
Name:SON, YUAN JEANIE
Entity type:Individual
Prefix:
First Name:YUAN
Middle Name:JEANIE
Last Name:SON
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 1:7625 EASTERN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4515
Mailing Address - Country:US
Mailing Address - Phone:323-773-3800
Mailing Address - Fax:562-928-6275
Practice Address - Street 1:7625 EASTERN AVE STE C
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-4515
Practice Address - Country:US
Practice Address - Phone:323-773-3800
Practice Address - Fax:562-928-6275
Is Sole Proprietor?:No
Enumeration Date:2011-09-03
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19364183500000X
CA73230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist