Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G77949 | CA |
NPI | 1003995648 |
---|---|
Provider Name | Qingwei Robert Yan |
First Address | Oakland, CA 94609-3210 |
Second Address | Oakland, CA 94609-3210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 20/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G779490 | (05) | CA |
G79726 | (02) | CA |