Healthcare Provider Details

I. General information

NPI: 1649101940
Provider Name (Legal Business Name): JACK YUAN, DPM P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HILTON AVE STE 208
HEMPSTEAD NY
11550-8116
US

IV. Provider business mailing address

98 LAWRENCE ST
TAPPAN NY
10983-2625
US

V. Phone/Fax

Practice location:
  • Phone: 845-480-1804
  • Fax: 718-224-5209
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JACK YUAN
Title or Position: PODIATRIST
Credential: DPM
Phone: 845-480-1804