Provider Demographics
NPI:1003995648
Name:YAN, QINGWEI ROBERT (MD)
Entity type:Individual
Prefix:
First Name:QINGWEI
Middle Name:ROBERT
Last Name:YAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 TELEGRAPH AVE STE 3000
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3210
Mailing Address - Country:US
Mailing Address - Phone:510-238-1238
Mailing Address - Fax:510-238-1338
Practice Address - Street 1:3100 TELEGRAPH AVE STE 3000
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3210
Practice Address - Country:US
Practice Address - Phone:510-238-1238
Practice Address - Fax:510-238-1338
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77949208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G779490Medicaid
CA00G779490Medicaid
CAG79726Medicare UPIN