Provider Demographics
NPI:1265148696
Name:DU, HAOYUAN (PA-C)
Entity type:Individual
Prefix:
First Name:HAOYUAN
Middle Name:
Last Name:DU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13526 ROOSEVELT AVE # 8G
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6818
Mailing Address - Country:US
Mailing Address - Phone:646-725-6864
Mailing Address - Fax:
Practice Address - Street 1:13526 ROOSEVELT AVE # 8G
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6818
Practice Address - Country:US
Practice Address - Phone:646-725-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant