Provider Demographics
NPI:1689692733
Name:YIN, DONGFANG DIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:DONGFANG DIANA
Middle Name:
Last Name:YIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:D. DIANA
Other - Middle Name:
Other - Last Name:YIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1445 CITY AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3831
Mailing Address - Country:US
Mailing Address - Phone:610-910-3889
Mailing Address - Fax:
Practice Address - Street 1:1445 CITY LINE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3831
Practice Address - Country:US
Practice Address - Phone:215-473-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-066380-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8011800Medicaid
PA001722584Medicaid