Provider Demographics
NPI:1558599498
Name:DIANNA YAN MD PC
Entity type:Organization
Organization Name:DIANNA YAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-963-0900
Mailing Address - Street 1:8909 SHADY GROVE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1308
Mailing Address - Country:US
Mailing Address - Phone:301-963-0900
Mailing Address - Fax:301-963-9694
Practice Address - Street 1:8909 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1308
Practice Address - Country:US
Practice Address - Phone:301-963-0900
Practice Address - Fax:301-963-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD755631400Medicaid
MD133049OtherMEDICARE PTAN
MD133049OtherMEDICARE PTAN