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General NPI Number Information
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NPI Number | 1093036162
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Entity Type | Individual
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Provider Name | BENJAMIN CORNELL YAN M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 700 NE 87TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98664-1913
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Country | US
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Telephone | 360-882-2778
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4825
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City | PORTLAND
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State | OR
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Zip | 97208-4825
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Country | US
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Telephone | 360-882-2778
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Fax | 360-604-1771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 01068194A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 036122845
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 55604
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | MD61062009
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License Number State | WA
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