Provider Demographics
NPI:1477057602
Name:KUAN, YESENIA (MD)
Entity Type:Individual
Prefix:MS
First Name:YESENIA
Middle Name:
Last Name:KUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 SW 171ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4053
Mailing Address - Country:US
Mailing Address - Phone:305-766-2909
Mailing Address - Fax:
Practice Address - Street 1:1450 MADRUGA AVE STE 302
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3164
Practice Address - Country:US
Practice Address - Phone:305-857-9800
Practice Address - Fax:305-857-9802
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1523392084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112251700Medicaid