Provider Demographics
NPI:1508056680
Name:YAN, YIJUN (MD)
Entity Type:Individual
Prefix:
First Name:YIJUN
Middle Name:
Last Name:YAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 29568
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27429-9568
Mailing Address - Country:US
Mailing Address - Phone:336-273-2511
Mailing Address - Fax:336-370-0287
Practice Address - Street 1:912 THIRD STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6967
Practice Address - Country:US
Practice Address - Phone:336-273-2511
Practice Address - Fax:336-370-0287
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-09002084N0400X, 2084D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM14700-011Medicare PIN
NCPENDINGMedicare UPIN