Healthcare Provider Details

I. General information

NPI: 1265496376
Provider Name (Legal Business Name): GREGORY YANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W 24TH ST
YUMA AZ
85364-6233
US

IV. Provider business mailing address

1320 W 24TH ST
YUMA AZ
85364-6233
US

V. Phone/Fax

Practice location:
  • Phone: 928-317-2518
  • Fax: 928-317-1811
Mailing address:
  • Phone: 928-317-2518
  • Fax: 928-317-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number18483
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: