1598782245 NPI number — Q. ROBERT YAN, M.D. PROFESSIONAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598782245 NPI number — Q. ROBERT YAN, M.D. PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Q. ROBERT YAN, M.D. PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598782245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 TELEGRAPH AVE
Provider Second Line Business Mailing Address:
SUITE 3000
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94609-3210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-238-1238
Provider Business Mailing Address Fax Number:
510-238-1338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 TELEGRAPH AVE
Provider Second Line Business Practice Location Address:
SUITE 3000
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-238-1238
Provider Business Practice Location Address Fax Number:
510-238-1338
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YAN
Authorized Official First Name:
QINGWEI
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
510-238-1238

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  G77949 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00G779490 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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