Healthcare Provider Details

I. General information

NPI: 1437221801
Provider Name (Legal Business Name): YU MEI WU FAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 GERARD AVENUE
BRONX NY
10452
US

IV. Provider business mailing address

1216 160TH STREET
BEECHHURST NY
11357
US

V. Phone/Fax

Practice location:
  • Phone: 718-588-7767
  • Fax: 718-537-7659
Mailing address:
  • Phone: 718-767-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number113408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: