Healthcare Provider Details

I. General information

NPI: 1295826782
Provider Name (Legal Business Name): HOMING YIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W LAKE LANSING RD
EAST LANSING MI
48823-1437
US

IV. Provider business mailing address

307 W LAKE LANSING RD
EAST LANSING MI
48823-1437
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-4480
  • Fax: 517-487-0193
Mailing address:
  • Phone: 517-487-4480
  • Fax: 517-487-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number4301031794
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: