Healthcare Provider Details

I. General information

NPI: 1740126168
Provider Name (Legal Business Name): YAW ANSONG-ANSONGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 KULA GULF WAY APT 105
ALBANY CA
94706-2690
US

IV. Provider business mailing address

670 KULA GULF WAY APT 105
ALBANY CA
94706-2690
US

V. Phone/Fax

Practice location:
  • Phone: 203-343-8629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZG1000X
TaxonomyMedical Geneticist (PhD) Specialist/Technologist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: