Healthcare Provider Details

I. General information

NPI: 1124177092
Provider Name (Legal Business Name): TAI FUNG YANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 BREVARD AVE
ROCKLEDGE FL
32955-2141
US

IV. Provider business mailing address

980 BREVARD AVE
ROCKLEDGE FL
32955-2141
US

V. Phone/Fax

Practice location:
  • Phone: 321-633-9973
  • Fax: 321-633-3120
Mailing address:
  • Phone: 321-633-9973
  • Fax: 321-633-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME70850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: