Provider Demographics
NPI:1306365564
Name:DR. YAN MEDICAL PLLC
Entity Type:Organization
Organization Name:DR. YAN MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAORONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-250-1085
Mailing Address - Street 1:13630 MAPLE AVE
Mailing Address - Street 2:SUITE 2-I
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11335-3865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13630 MAPLE AVE
Practice Address - Street 2:SUITE 2-I
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3824
Practice Address - Country:US
Practice Address - Phone:646-250-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty