Provider Demographics
NPI:1619932076
Name:LI, YAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:YAN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4666 MCDERMOTT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7772
Mailing Address - Country:US
Mailing Address - Phone:972-668-6868
Mailing Address - Fax:972-668-1618
Practice Address - Street 1:4666 MCDERMOTT RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7772
Practice Address - Country:US
Practice Address - Phone:972-668-6868
Practice Address - Fax:972-668-1618
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039143502Medicaid
TX039143502Medicaid
TX8B4013Medicare PIN