Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101248968 | VA |
Y | 2081S0010X | Sports Medicine | D0074228 | MD |
Y | 213ES0000X | Sports Medicine | D0074228 | MD |
N | 2081S0010X | Sports Medicine | MD443050 | PA |
N | 213ES0000X | Sports Medicine | MD443050 | PA |
NPI | 1285896407 |
---|---|
Provider Name | Mike Yuan |
First Address | Rockville, MD 20850-4031 |
Second Address | Rockville, MD 20850-4031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2008 |
Last Update Date | 21/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
243224 | MEDICARE PTAN (01) | DC |
243456 | MEDICARE PTAN (01) | MD |