Provider Demographics
NPI:1194246355
Name:GUAN, YAQUAN
Entity type:Individual
Prefix:
First Name:YAQUAN
Middle Name:
Last Name:GUAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KENNY
Other - Middle Name:
Other - Last Name:GUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7207 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2008
Mailing Address - Country:US
Mailing Address - Phone:718-232-0888
Mailing Address - Fax:718-232-2493
Practice Address - Street 1:7207 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2008
Practice Address - Country:US
Practice Address - Phone:718-232-0888
Practice Address - Fax:718-232-2493
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care