Provider Demographics
NPI:1083308191
Name:GUAN, JIAN MIN (NP)
Entity Type:Individual
Prefix:
First Name:JIAN MIN
Middle Name:
Last Name:GUAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ROSS LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1234
Mailing Address - Country:US
Mailing Address - Phone:646-469-7618
Mailing Address - Fax:
Practice Address - Street 1:3907 PRINCE ST STE 4F
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5308
Practice Address - Country:US
Practice Address - Phone:718-939-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily