Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 01081595A | IN |
N | 2086S0120X | Pediatric Surgery | 036.129094 | IL |
N | 2086S0120X | Pediatric Surgery | 2009001314 | MO |
N | 2086S0120X | Pediatric Surgery | MD37812 | TN |
NPI | 1629165741 |
---|---|
Provider Name | Edmund Yi-Bin Yang |
First Address | University City, MO 63130-4661 |
Second Address | University City, MO 63130-4661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 05/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H92128 | (02) |