Provider Demographics
NPI:1346762267
Name:WISSEH, YANCUN (MS)
Entity Type:Individual
Prefix:
First Name:YANCUN
Middle Name:
Last Name:WISSEH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1420
Mailing Address - Country:US
Mailing Address - Phone:215-868-8293
Mailing Address - Fax:
Practice Address - Street 1:236 SPRING VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023
Practice Address - Country:US
Practice Address - Phone:215-868-8293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2024-04-17
Deactivation Date:2017-12-05
Deactivation Code:
Reactivation Date:2022-11-16