Healthcare Provider Details

I. General information

NPI: 1497177323
Provider Name (Legal Business Name): YAN DORNEICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YAN GU M.D.

II. Dates (important events)

Enumeration Date: 01/12/2014
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LYLTON AVE, STE 300 UPMC KIDNEY CLINIC
PITTSBURGH PA
15213
US

IV. Provider business mailing address

2 HOT METAL ST QUANTUM ONE, SUITE 001
PITTSBURGH PA
15203-2348
US

V. Phone/Fax

Practice location:
  • Phone: 412-802-3043
  • Fax: 412-802-4950
Mailing address:
  • Phone: 412-647-3087
  • Fax: 412-432-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD457090
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: