Provider Demographics
NPI:1255881868
Name:GUAN, HUIYAN (DDS,MS)
Entity type:Individual
Prefix:
First Name:HUIYAN
Middle Name:
Last Name:GUAN
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400C SOUTHPARK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2974
Mailing Address - Country:US
Mailing Address - Phone:804-823-9543
Mailing Address - Fax:
Practice Address - Street 1:400C SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2974
Practice Address - Country:US
Practice Address - Phone:804-526-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0309641223X0400X
VA04014153891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics