Healthcare Provider Details

I. General information

NPI: 1992456537
Provider Name (Legal Business Name): SU YUAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 EAST 70TH STREET, STARR-4
NEW YORK NY
10021
US

IV. Provider business mailing address

520 EAST 70TH STREET, STARR-4
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-2243
  • Fax:
Mailing address:
  • Phone: 646-962-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number312944
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number312944
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: