Physician Compare National (NPI:1710206180)

HEALTHCARE PROVIDER: STEPHANIE ROSE BELTRAN YAN

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1710206180
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2769715911
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190604000539
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	YAN
	Individual professional last name
Provider First Name	STEPHANIE ROSE
	Individual professional first name
Provider Middle Name	BELTRAN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF CALIFORNIA, DAVIS SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CRITICAL CARE (INTENSIVISTS)
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CRITICAL CARE (INTENSIVISTS)
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1830 WELLS ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 103
	Group Practice or individual's line 2 address
City	WAILUKU
	Group Practice or individual's city
State	HI
	Group Practice or individual's state
Zip Code	967932365
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	120002
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MAUI MEMORIAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y