Provider Demographics
NPI:1821160540
Name:WANG, YAN (MD,)
Entity Type:Individual
Prefix:MS
First Name:YAN
Middle Name:
Last Name:WANG
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 1:42-35 MAIN ST
Mailing Address - Street 2:SUITE 3J
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4721
Mailing Address - Country:US
Mailing Address - Phone:917-291-7317
Mailing Address - Fax:
Practice Address - Street 1:42-35 MAIN ST
Practice Address - Street 2:SUITE 3J
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4721
Practice Address - Country:US
Practice Address - Phone:917-291-7317
Practice Address - Fax:718-321-7510
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02814822Medicaid