Healthcare Provider Details

I. General information

NPI: 1265585939
Provider Name (Legal Business Name): DAVID YAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 PINEBROOK RD STE 205
NORTH VENICE FL
34275-3955
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-261-0060
  • Fax: 941-262-0921
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME124629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: