MEDICARE: DR. LESTER YAN MD

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	33218	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	730290003	OTHER	WI	MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497862387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESTER YAN MD

Provider Business Mailing Address
First Line	:	13380 W TREPANIA RD
Second Line	:	LAC COURTE OREILLES COMMUNITY HEALTH CTR
City	:	HAYWARD
State	:	WI
Zip	:	54843-2186
Country	:	US
Telephone Number	:	715-638-5100
Fax Number	:	715-634-2740

Provider Business Practice Location Address
First Line	:	13380 W TREPANIA RD
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-2186
Country	:	US
Telephone Number	:	715-638-5100
Fax Number	:	715-634-2740

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. LESTER YAN MD” Practice Location

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