Healthcare Provider Details

I. General information

NPI: 1871595009
Provider Name (Legal Business Name): LEO A YANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MALVERN AVE STE 401
HOT SPRINGS AR
71901-7779
US

IV. Provider business mailing address

1900 MALVERN AVE STE 401
HOT SPRINGS AR
71901-7779
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-6455
  • Fax: 501-624-5896
Mailing address:
  • Phone: 501-623-6455
  • Fax: 501-624-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberN8304
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: