Provider Demographics
NPI:1528805140
Name:YUAN, LI-WEI (PSYD)
Entity type:Individual
Prefix:DR
First Name:LI-WEI
Middle Name:
Last Name:YUAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KYLE
Other - Middle Name:
Other - Last Name:YUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:247 WADSWORTH AVE APT 3W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2507
Mailing Address - Country:US
Mailing Address - Phone:626-898-0583
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1197
Practice Address - Country:US
Practice Address - Phone:718-918-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026338103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist