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Individual

YI FAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
875 PERIMETER DR, MOSCOW, ID 83844-9803
(208) 885-6111
Mailing address
422 E 8TH ST APT 2, MOSCOW, ID 83843-5200
(208) 874-9320

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary

Other

Enumeration date
05/17/2021
Last updated
05/17/2021
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Product
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