=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437474970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALUS MEDICAL FLUSHING PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2010
-----------------------------------------------------
Last Update Date | 03/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41-40 UNION STREET #2
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-2540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-886-9098
-----------------------------------------------------
Fax | 718-886-2086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41-40 UNION STREET #2
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-2540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-886-9098
-----------------------------------------------------
Fax | 718-886-2086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. HENRY JC YAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-886-9098
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 250203
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------