Provider Demographics
NPI:1962515742
Name:YAN, TOM DEJIAN (MD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:DEJIAN
Last Name:YAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 NW MYHRE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7662
Mailing Address - Country:US
Mailing Address - Phone:564-240-4000
Mailing Address - Fax:564-240-4049
Practice Address - Street 1:1950 NW MYHRE RD FL 2
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7662
Practice Address - Country:US
Practice Address - Phone:564-240-4000
Practice Address - Fax:564-240-4049
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26497207RC0200X, 207RP1001X
WAMD00046082207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine