Provider Demographics
NPI:1598782245
Name:Q. ROBERT YAN, M.D. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:Q. ROBERT YAN, M.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QINGWEI
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-238-1238
Mailing Address - Street 1:3100 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3210
Mailing Address - Country:US
Mailing Address - Phone:510-238-1238
Mailing Address - Fax:510-238-1338
Practice Address - Street 1:3100 TELEGRAPH AVE
Practice Address - Street 2:SUITE 3000
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3210
Practice Address - Country:US
Practice Address - Phone:510-238-1238
Practice Address - Fax:510-238-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77949208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G779490Medicaid
CA00G779490Medicaid
CA00G779490Medicare ID - Type Unspecified