Provider Demographics
NPI:1659315000
Name:YANG, YAN (MD)
Entity Type:Individual
Prefix:DR
First Name:YAN
Middle Name:
Last Name:YANG
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 1:2801 RODEO RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6503
Mailing Address - Country:US
Mailing Address - Phone:505-438-7178
Mailing Address - Fax:505-438-1056
Practice Address - Street 1:2801 RODEO RD
Practice Address - Street 2:SUITE F
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6503
Practice Address - Country:US
Practice Address - Phone:505-438-7178
Practice Address - Fax:505-438-1056
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0461208100000X
NM296171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM00R30QOtherBLUE CROSS BLUE SHIELD