Provider Demographics
NPI:1710206180
Name:YAN, STEPHANIE ROSE BELTRAN
Entity Type:Individual
Prefix:
First Name:STEPHANIE ROSE
Middle Name:BELTRAN
Last Name:YAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 HUKU LII PL STE 304
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7062
Mailing Address - Country:US
Mailing Address - Phone:808-977-0955
Mailing Address - Fax:808-430-6060
Practice Address - Street 1:411 HUKU LII PL STE 304
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7062
Practice Address - Country:US
Practice Address - Phone:808-977-0955
Practice Address - Fax:808-439-6060
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125106208600000X
HIMD19100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery