Provider Demographics
NPI:1184016008
Name:YUAN, LEWIS WEI-CHIAN
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:WEI-CHIAN
Last Name:YUAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 N SHEFFIELD AVE
Mailing Address - Street 2:UNIT 302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7105
Mailing Address - Country:US
Mailing Address - Phone:856-294-7474
Mailing Address - Fax:
Practice Address - Street 1:3301 N SHEFFIELD AVE
Practice Address - Street 2:UNIT 302
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7105
Practice Address - Country:US
Practice Address - Phone:856-294-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program