Healthcare Provider Details

I. General information

NPI: 1225073331
Provider Name (Legal Business Name): PEDIATRIC CARE OF LANSING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 E GRAND RIV SUITE 109
LANSING MI
48912-4300
US

IV. Provider business mailing address

2909 E GRAND RIV SUITE 109
LANSING MI
48912-4300
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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberHY031794
License Number StateMI

VIII. Authorized Official

Name: DR. HOMING YIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 517-487-4480