Provider Demographics
NPI:1326050188
Name:YUAN, MIKE NANYONG (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:NANYONG
Last Name:YUAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BERENGER PL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5657
Mailing Address - Country:US
Mailing Address - Phone:713-490-1493
Mailing Address - Fax:713-588-2428
Practice Address - Street 1:1065 GESSNER RD
Practice Address - Street 2:STE 203
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6061
Practice Address - Country:US
Practice Address - Phone:713-490-1493
Practice Address - Fax:713-588-2428
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK71252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00020160OtherHUMANA
2683468OtherATNEA HMO
P00004223OtherRAILROAD MEDICARE
05-00377OtherUNITED HEALTHCARE
49GKOtherBCBS
6944559-005OtherCIGNA
TX029933101Medicaid
ONE HEALTH PLANOther891214
7374142OtherATNEA
00020160OtherHUMANA
00268MMedicare ID - Type Unspecified