Provider Demographics
NPI:1639744683
Name:ZHOU, YAN (MSTOM)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:ZHOU
Suffix:
Gender:F
Credentials:MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 BOWNE ST APT 3N
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5625
Mailing Address - Country:US
Mailing Address - Phone:347-440-3905
Mailing Address - Fax:
Practice Address - Street 1:271 1ST AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2985
Practice Address - Country:US
Practice Address - Phone:347-440-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006942171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist