Provider Demographics
NPI:1114703477
Name:YOU, MENGYUAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MENGYUAN
Middle Name:
Last Name:YOU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 7TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4660
Mailing Address - Country:US
Mailing Address - Phone:718-360-7666
Mailing Address - Fax:718-450-8919
Practice Address - Street 1:5604 7TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4660
Practice Address - Country:US
Practice Address - Phone:718-360-7666
Practice Address - Fax:718-450-8919
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY030374-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant