MEDICARE: QUAN YUAN

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891415394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUAN YUAN

Provider Business Mailing Address
First Line	:	230 W CERMAK RD FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-5013
Country	:	US
Telephone Number	:	312-225-8659
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 W CERMAK RD FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-5013
Country	:	US
Telephone Number	:	312-225-8659
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	09/02/2022

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Directions to “ QUAN YUAN ” Practice Location

Language	Start Address	Practice Location

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