MEDICARE: XUE YANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker		MN

General Provider Information

NPI Number	:	1396416467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XUE YANG

Provider Business Mailing Address
First Line	:	6048 UPPER 51ST ST N APT 111
Second Line	:
City	:	OAKDALE
State	:	MN
Zip	:	55128-1310
Country	:	US
Telephone Number	:	608-385-4882
Fax Number	:

Provider Business Practice Location Address
First Line	:	1265 GREY FOX RD STE 2
Second Line	:
City	:	ARDEN HILLS
State	:	MN
Zip	:	55112-6929
Country	:	US
Telephone Number	:	651-612-8612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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Directions to “ XUE YANG ” Practice Location

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