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General NPI Number Information
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NPI Number | 1427413954
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Entity Type | Individual
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Provider Name | JIE YAN M.D. PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202
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Country | US
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Telephone | 313-829-7809
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 ALISOP PL APT 305
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City | TROY
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State | MI
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Zip | 48084-3470
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Country | US
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Telephone | 617-824-0572
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Fax |
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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 | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number | 4301114114
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NM
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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 | 4301114114
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License Number State | MI
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