Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 273124 | OR |
Y | 111NI0013X | Independent Medical Examiner | 273124 | OR |
NPI | 1366631657 |
---|---|
Provider Name | Mr. Dan Min Yan |
First Address | Portland, OR 97206-2453 |
Second Address | Portland, OR 97206-2453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2007 |
Last Update Date | 23/10/2007 |