Provider Demographics
NPI:1033110788
Name:YAN, XIAOJUN (MD)
Entity Type:Individual
Prefix:DR
First Name:XIAOJUN
Middle Name:
Last Name:YAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:XIAOJUN
Other - Last Name:YAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3131 KINGS HWY
Mailing Address - Street 2:SUITE D10
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-252-3590
Mailing Address - Fax:718-252-6957
Practice Address - Street 1:3131 KINGS HWY
Practice Address - Street 2:SUITE D10
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-252-3590
Practice Address - Fax:718-252-6957
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2011-03-24
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
NY196486207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY123593OtherVYTRA HEALTH PLAN
NY2186828OtherAETNA/US HEALTH
NY4770612OtherCIGNA
NY3C5321OtherHEALTH NET
NYP1004706OtherOXFORD
NYYR6486OtherATLANTIS
NY32166POtherH.I.P.
NY79844OtherGHI/HMO
NY01523142Medicaid
NY1446208OtherUNITED HEALTHCARE
NY2199426OtherFIRST HEALTH
NY089347OtherBETTER HEALTH ADVANTAGE
NY290011895OtherRAILROAD/MEDICARE
NY123593OtherVYTRA HEALTH PLAN
NY3C5321OtherHEALTH NET