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NPI Code Detail

MEDICARE: JUSTIN YAN

MEDICARE: JUSTIN YAN
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianDO204586OR

General Provider Information

NPI Number : 1306290093
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN YAN
Provider Business Mailing Address
First Line : 500 NE MULTNOMAH ST STE 100
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2031
Country : US
Telephone Number : 800-813-2000
Fax Number : 855-524-5255
Provider Business Practice Location Address
First Line : 10060 NE EVERGREEN PKWY
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-6448
Country : US
Telephone Number : 800-813-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2016
Last Update Date : 08/06/2025

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