Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD454151 | PA |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD454151 | PA |
NPI | 1265788962 |
---|---|
Provider Name | Michael Yang |
First Address | Newtown, PA 18940-1873 |
Second Address | Darby, PA 19023-1330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2012 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103035399 | (05) | PA |