Provider Demographics
NPI:1831350271
Name:WAN, SAU YIN (MD)
Entity type:Individual
Prefix:DR
First Name:SAU YIN
Middle Name:
Last Name:WAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 HAROLD FLEMING COURT
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4225
Mailing Address - Country:US
Mailing Address - Phone:864-573-6320
Mailing Address - Fax:864-573-6323
Practice Address - Street 1:151 HAROLD FLEMING COURT
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4225
Practice Address - Country:US
Practice Address - Phone:864-573-6320
Practice Address - Fax:864-573-6323
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30869207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3212Medicaid
SC308697Medicaid
SCP01699515OtherRAILROAD MEDICARE
SC308697Medicaid
SCP01699515OtherRAILROAD MEDICARE
SCCB6976Medicare PIN
SCAA30117034Medicare PIN