Provider Demographics
NPI:1255347001
Name:DONG, YIJIE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:YIJIE
Middle Name:
Last Name:DONG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4096
Mailing Address - Country:US
Mailing Address - Phone:763-201-8051
Mailing Address - Fax:
Practice Address - Street 1:229 JACKSON ST
Practice Address - Street 2:STE 100
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2287
Practice Address - Country:US
Practice Address - Phone:763-201-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN399602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG63772Medicare UPIN