Provider Demographics
NPI:1891793782
Name:LIAN, YI Y (MD)
Entity Type:Individual
Prefix:
First Name:YI
Middle Name:Y
Last Name:LIAN
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 1:3303 SE 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1912
Mailing Address - Country:US
Mailing Address - Phone:541-430-7868
Mailing Address - Fax:
Practice Address - Street 1:3303 SE 89TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1912
Practice Address - Country:US
Practice Address - Phone:541-430-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288043Medicaid
ORG57310Medicare UPIN
OR115986Medicare ID - Type Unspecified