Provider Demographics
NPI:1831355874
Name:YAN WANG MEDICAL P.C.
Entity type:Organization
Organization Name:YAN WANG MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-321-7410
Mailing Address - Street 1:4160 MAIN ST STE 217
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3899
Mailing Address - Country:US
Mailing Address - Phone:718-321-7410
Mailing Address - Fax:718-321-7510
Practice Address - Street 1:4160 MAIN ST STE 217
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3899
Practice Address - Country:US
Practice Address - Phone:718-321-7410
Practice Address - Fax:718-321-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty