Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MT049106T | PA |
N | 208600000X | Surgeon | MT049106T | PA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 047323 | CT |
NPI | 1265585939 |
---|---|
Provider Name | David Yan |
First Address | Venice, FL 34293-2232 |
Second Address | Venice, FL 34293-2232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 22/09/2020 |