MEDICARE: EMILY RUEY JIUAN YAN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2024015820	MO

General Provider Information

NPI Number	:	1205494952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY RUEY JIUAN YAN DO

Provider Business Mailing Address
First Line	:	3530 W MOUNT VERNON ST STE 110
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-5207
Country	:	US
Telephone Number	:	417-730-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 W MOUNT VERNON ST STE 110
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-5207
Country	:	US
Telephone Number	:	417-730-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	09/23/2025

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