Provider Demographics
NPI:1265061691
Name:YAN, KEVIN YIMING (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:YIMING
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 1:1365B CLIFTON RD NE STE B4500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-5360
Mailing Address - Fax:404-778-4849
Practice Address - Street 1:1365B CLIFTON RD NE STE B4500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-3220
Practice Address - Country:US
Practice Address - Phone:047-785-3604
Practice Address - Fax:404-778-4849
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA99076207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program