Healthcare Provider Details

I. General information

NPI: 1972593325
Provider Name (Legal Business Name): EDWARD J. YANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1964 HAPAKI ST
AIEA HI
96701-1639
US

IV. Provider business mailing address

98-1964 HAPAKI ST
AIEA HI
96701-1639
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-6334
  • Fax: 808-433-2631
Mailing address:
  • Phone: 808-433-6334
  • Fax: 808-433-2631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number7465
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: