Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MDD002366018 | MD |
NPI | 1073567129 |
---|---|
Provider Name | Tony Yan |
First Address | Baltimore, MD 21237-3960 |
Second Address | Baltimore, MD 21237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 13/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
781651100 | (05) | MD |
C48974 | (02) |