Healthcare Provider Details

I. General information

NPI: 1912256033
Provider Name (Legal Business Name): YAN WANG FNP-BC, DCNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13259 41ST RD STE CB
FLUSHING NY
11355-4256
US

IV. Provider business mailing address

289 KILBURN RD S
GARDEN CITY NY
11530-5326
US

V. Phone/Fax

Practice location:
  • Phone: 917-962-7920
  • Fax:
Mailing address:
  • Phone: 516-790-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337238
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: