Provider Demographics
NPI:1225073331
Name:PEDIATRIC CARE OF LANSING PC
Entity Type:Organization
Organization Name:PEDIATRIC CARE OF LANSING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMING
Authorized Official - Middle Name:
Authorized Official - Last Name:YIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-487-4480
Mailing Address - Street 1:2909 E GRAND RIV
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4300
Mailing Address - Country:US
Mailing Address - Phone:517-487-4480
Mailing Address - Fax:517-487-0193
Practice Address - Street 1:2909 E GRAND RIV
Practice Address - Street 2:SUITE 109
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4300
Practice Address - Country:US
Practice Address - Phone:517-487-4480
Practice Address - Fax:517-487-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHY031794261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3182220Medicaid
MI1064361Medicaid
MI4233548Medicaid
MI5182238Medicaid