Provider Demographics
NPI:1801074596
Name:YUAN, FA-WEI
Entity type:Individual
Prefix:MR
First Name:FA-WEI
Middle Name:
Last Name:YUAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2748
Mailing Address - Country:US
Mailing Address - Phone:718-520-2334
Mailing Address - Fax:718-268-9680
Practice Address - Street 1:10002 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2748
Practice Address - Country:US
Practice Address - Phone:718-520-2334
Practice Address - Fax:718-268-9680
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist