Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 105712 | MN |
Y | 208600000X | Surgeon | 105712 | MN |
NPI | 1003863366 |
---|---|
Provider Name | Henry P. Yang |
First Address | Saint Cloud, MN 56303-2255 |
Second Address | Saint Cloud, MN 56303-2255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 16/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G91899 | (02) |