Provider Demographics
NPI:1962404335
Name:CALIFORNIA CANCER INSTITUTE A MEDICAL CORPORATION
Entity type:Organization
Organization Name:CALIFORNIA CANCER INSTITUTE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YUN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-288-0008
Mailing Address - Street 1:1301 OAKLAWN RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-1006
Mailing Address - Country:US
Mailing Address - Phone:626-288-0008
Mailing Address - Fax:909-593-5588
Practice Address - Street 1:600 N GARFIELD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1166
Practice Address - Country:US
Practice Address - Phone:626-288-0008
Practice Address - Fax:909-593-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098210Medicaid
CAGR0098210Medicaid