Provider Demographics
NPI:1861506446
Name:MIROW, YUAN YUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:YUAN
Middle Name:YUAN
Last Name:MIROW
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 1:801 ARCH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2412
Mailing Address - Country:US
Mailing Address - Phone:215-955-5279
Mailing Address - Fax:215-923-5775
Practice Address - Street 1:801 ARCH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2412
Practice Address - Country:US
Practice Address - Phone:215-955-5279
Practice Address - Fax:215-923-5775
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065962L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017086000004Medicaid
PAG80732Medicare UPIN