Basic Information
Provider Information
NPI: 1265762777
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YEH
FirstName: BRIAN
MiddleName: K
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4100 BEECHER RD STE A
Address2:  
City: FLINT
State: MI
PostalCode: 485323661
CountryCode: US
TelephoneNumber: 8103423813
FaxNumber: 8103423784
Practice Location
Address1: 4100 BEECHER RD STE A
Address2:  
City: FLINT
State: MI
PostalCode: 485323661
CountryCode: US
TelephoneNumber: 8103423800
FaxNumber: 9893423784
Other Information
ProviderEnumerationDate: 01/05/2010
LastUpdateDate: 05/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001XA102731CAY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

No ID Information.


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