Provider Demographics
NPI:1669533576
Name:YAN, XIAOTIAN (MD)
Entity type:Individual
Prefix:
First Name:XIAOTIAN
Middle Name:
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 1:1608 S J ST FL 3
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7503
Mailing Address - Fax:360-782-5899
Practice Address - Street 1:1608 S J ST FL 3
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7503
Practice Address - Fax:360-782-5899
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046910207Q00000X
ORMD28982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0334865OtherSTATE L&I
OR500610864Medicaid
WA2002218Medicaid
WA0282210OtherWA L&I
WAG8881321Medicare PIN
WA0334865OtherSTATE L&I
ORR161384Medicare PIN
WAG8935295Medicare PIN