Provider Demographics
NPI:1033156740
Name:YUAN, TONY HUE-DAN (MD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:HUE-DAN
Last Name:YUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 POWELL STREET
Mailing Address - Street 2:STE 920
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1803
Mailing Address - Country:US
Mailing Address - Phone:510-350-2777
Mailing Address - Fax:
Practice Address - Street 1:225 NORTH JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:94608-1803
Practice Address - Country:US
Practice Address - Phone:510-350-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9806A207P00000X
MTMED-PHYS-LIC-34023207P00000X
UT9064844-1205207P00000X
NMMD2014-0724207P00000X
NV15481207P00000X
CODR.0054437207P00000X
IDM-12661207P00000X
WAMD60476217207P00000X
HIMD-18004207P00000X
ORMD168822207P00000X
AZ49508207P00000X
NY281239207P00000X
FLME125239207P00000X
PAMD455902207P00000X
CAA65615207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG49345Medicare UPIN