Provider Demographics
NPI:1588121057
Name:TIAN, YI
Entity type:Individual
Prefix:
First Name:YI
Middle Name:
Last Name:TIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ASCOT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2913
Mailing Address - Country:US
Mailing Address - Phone:413-346-8174
Mailing Address - Fax:
Practice Address - Street 1:4 ASCOT RIDGE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2913
Practice Address - Country:US
Practice Address - Phone:413-346-8174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program