Provider Demographics
NPI:1588752521
Name:WANG, YAN (MD)
Entity type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4831
Mailing Address - Country:US
Mailing Address - Phone:718-457-0002
Mailing Address - Fax:718-457-9108
Practice Address - Street 1:8701 56TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4831
Practice Address - Country:US
Practice Address - Phone:718-457-0002
Practice Address - Fax:718-457-9108
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02197244Medicaid
NY02197244Medicaid
NYH18438Medicare UPIN