Provider Demographics
NPI:1417676966
Name:YI, CALVIN TIAN (PA-S)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:TIAN
Last Name:YI
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 NE 1ST CIR
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-2900
Mailing Address - Country:US
Mailing Address - Phone:425-647-8765
Mailing Address - Fax:
Practice Address - Street 1:5627 NE 1ST CIR
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-2900
Practice Address - Country:US
Practice Address - Phone:425-647-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program