Provider Demographics
NPI:1982327755
Name:YAN, YUANYUAN
Entity type:Individual
Prefix:MRS
First Name:YUANYUAN
Middle Name:
Last Name:YAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RENA
Other - Middle Name:
Other - Last Name:YAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5 JEFFERSON CT
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1118
Mailing Address - Country:US
Mailing Address - Phone:934-949-8281
Mailing Address - Fax:
Practice Address - Street 1:6278 NY-25A
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792
Practice Address - Country:US
Practice Address - Phone:631-886-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007140171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist