MEDICARE: KELLY YEUNG PA

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	363AS0400X	Surgical Physician Assistant
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1528406055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY YEUNG PA

Provider Business Mailing Address
First Line	:	1746 OJEMAN SPRING LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-1972
Country	:	US
Telephone Number	:	682-683-2301
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 KINGWOOD EXECUTIVE DR STE 150
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2765
Country	:	US
Telephone Number	:	682-683-2301
Fax Number	:

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

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	12/19/2023

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Directions to “ KELLY YEUNG PA” Practice Location

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