Healthcare Provider Details

I. General information

NPI: 1992736888
Provider Name (Legal Business Name): DAVID D.Y. LAN M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 STATE ROUTE 59
KENT OH
44240-4112
US

IV. Provider business mailing address

1930 STATE ROUTE 59
KENT OH
44240-4112
US

V. Phone/Fax

Practice location:
  • Phone: 330-677-3632
  • Fax: 330-572-3836
Mailing address:
  • Phone: 330-677-3632
  • Fax: 330-572-3836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.041595
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: