Provider Demographics
NPI:1447349097
Name:YGIEA INC
Entity type:Organization
Organization Name:YGIEA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIDHYUT
Authorized Official - Middle Name:
Authorized Official - Last Name:JANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-837-6158
Mailing Address - Street 1:9806 VENICE BL.
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2728
Mailing Address - Country:US
Mailing Address - Phone:310-837-6158
Mailing Address - Fax:310-837-6159
Practice Address - Street 1:9806 VENICE BL.
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2728
Practice Address - Country:US
Practice Address - Phone:310-837-6158
Practice Address - Fax:310-837-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
CAPHY383223336C0003X
PHY383223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0511205OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0511205OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA383220Medicaid
0511205OtherNCPDP PROVIDER ID #