Provider Demographics
NPI:1235765579
Name:YUFANYI, JOHN CTSIAMBU
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CTSIAMBU
Last Name:YUFANYI
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 1:12041 78TH ST NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4822
Mailing Address - Country:US
Mailing Address - Phone:612-636-3800
Mailing Address - Fax:763-777-9044
Practice Address - Street 1:12041 78TH ST NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-4822
Practice Address - Country:US
Practice Address - Phone:612-636-3800
Practice Address - Fax:763-777-9044
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN393078251E00000X
253Z00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care