1033110788 NPI number — DR. XIAOJUN YAN MD

Table of content: DR. XIAOJUN YAN MD (NPI 1033110788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033110788 NPI number — DR. XIAOJUN YAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAN
Provider First Name:
XIAOJUN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YAN
Provider Other First Name:
RICHARD
Provider Other Middle Name:
XIAOJUN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033110788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2006
NPI Reactivation Date:
03/29/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 KINGS HWY
Provider Second Line Business Mailing Address:
SUITE D10
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-252-3590
Provider Business Mailing Address Fax Number:
718-252-6957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3131 KINGS HWY
Provider Second Line Business Practice Location Address:
SUITE D10
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-252-3590
Provider Business Practice Location Address Fax Number:
718-252-6957
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  196486 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 123593 . This is a "VYTRA HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2186828 . This is a "AETNA/US HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4770612 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C5321 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1004706 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: YR6486 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 32166P . This is a "H.I.P." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 79844 . This is a "GHI/HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01523142 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1446208 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2199426 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 089347 . This is a "BETTER HEALTH ADVANTAGE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 290011895 . This is a "RAILROAD/MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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