Provider Demographics
NPI:1487474615
Name:LAN, JINYU
Entity type:Individual
Prefix:
First Name:JINYU
Middle Name:
Last Name:LAN
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 1:13620 MAPLE AVE # C705
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5166
Mailing Address - Country:US
Mailing Address - Phone:718-888-0316
Mailing Address - Fax:
Practice Address - Street 1:13849 62ND AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1101
Practice Address - Country:US
Practice Address - Phone:347-884-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant