MEDICARE: EDMUND YI-BIN YANG MD, PHD

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	2086S0120X	Pediatric Surgery Physician	036.129094	IL
2	2086S0120X	Pediatric Surgery Physician	2009001314	MO
3	2086S0120X	Pediatric Surgery Physician	MD37812	TN
4	2086S0120X	Pediatric Surgery Physician	01081595A	IN

General Provider Information

NPI Number	:	1629165741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMUND YI-BIN YANG MD, PHD

Provider Business Mailing Address
First Line	:	6814 WATERMAN AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-4661
Country	:	US
Telephone Number	:	314-537-5298
Fax Number	:

Provider Business Practice Location Address
First Line	:	6814 WATERMAN AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-4661
Country	:	US
Telephone Number	:	314-537-5298
Fax Number	:

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	02/05/2019

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