Basic Information
| Provider Information | |||||||||
| NPI: | 1780690875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAN | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E PENN SQ | ||||||||
| Address2: | 9TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191073323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2674259258 | ||||||||
| FaxNumber: | 2674259299 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 MARKET ST FL 2 | ||||||||
| Address2: | CHILDREN'S HOSPITAL OF PHILADELPHIA - DERMATOLOGY DIV | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191043366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155909119 | ||||||||
| FaxNumber: | 2155904948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | MD059207L | PA | Y | Allopathic & Osteopathic Physicians | Dermatology | 208000000X | MD059207L | PA | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 001625910 | 05 | PA | MEDICAID | 7197608 | 05 | NJ | MEDICAID |