Provider Demographics
NPI:1750533428
Name:YAN, HENRY JIANN CHERNG (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:JIANN CHERNG
Last Name:YAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIANN
Other - Middle Name:
Other - Last Name:YAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:41-40 UNION STREET
Mailing Address - Street 2:#2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2540
Mailing Address - Country:US
Mailing Address - Phone:718-886-9098
Mailing Address - Fax:718-888-6208
Practice Address - Street 1:41-40 UNION STREET
Practice Address - Street 2:#2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2540
Practice Address - Country:US
Practice Address - Phone:718-886-9098
Practice Address - Fax:718-886-2086
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03079536Medicaid
NYG400018513Medicare PIN