Healthcare Provider Details

I. General information

NPI: 1154902583
Provider Name (Legal Business Name): YANHAN REN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 LINCOLN ST
WORCESTER MA
01605-2138
US

IV. Provider business mailing address

281 LINCOLN ST
WORCESTER MA
01605-2138
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-1000
  • Fax:
Mailing address:
  • Phone: 508-334-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA207414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: