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NPI Code Detail

MEDICARE: YAN GENG MD

MEDICARE: YAN GENG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD60556212WA
2207QG0300XGeriatric Medicine (Family Medicine) PhysicianMD60556212WA

General Provider Information

NPI Number : 1104146620
Entity Type Code : Individual
Provider Name (Legal Business Name) : YAN GENG MD
Provider Business Mailing Address
First Line : PO BOX 3360
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3360
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1450 NORTHWEST LN SE STE A
Second Line :
City : LACEY
State : WA
Zip : 98503-6908
Country : US
Telephone Number : 360-491-4460
Fax Number : 360-491-3090
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2010
Last Update Date : 05/19/2021

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Directions to “ YAN GENG MD” Practice Location

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