Individual
DR. JIE SHI YAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2925 SYCAMORE DR, SUITE 160, SIMI VALLEY, CA 93065-1207
(805) 584-0177
(805) 584-1179
Mailing address
PO BOX 2160, MOORPARK, CA 93020-2160
(818) 718-2301
(818) 718-2311
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A78071
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A780710
—
CA
01
—
A78071
CALIFORNIA LICENSE NUMBER
CA
Enumeration date
07/19/2005
Last updated
07/18/2023
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