Healthcare Provider Details

I. General information

NPI: 1437544467
Provider Name (Legal Business Name): LINDA YAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PARK PL
HAZLE TOWNSHIP PA
18202-2885
US

IV. Provider business mailing address

10 PARK PL
HAZLE TOWNSHIP PA
18202-2885
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-1400
  • Fax: 570-234-0784
Mailing address:
  • Phone: 570-454-1400
  • Fax: 570-234-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD474884
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: