Healthcare Provider Details

I. General information

NPI: 1023291606
Provider Name (Legal Business Name): HAZEL YANG, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 CARTER AVE
ASHLAND KY
41101-7731
US

IV. Provider business mailing address

2025 CARTER AVE
ASHLAND KY
41101-7731
US

V. Phone/Fax

Practice location:
  • Phone: 606-325-1894
  • Fax: 606-325-9193
Mailing address:
  • Phone: 606-325-1894
  • Fax: 606-325-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number29156
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number00463P
License Number StateKY

VIII. Authorized Official

Name: DR. HAZEL YANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 606-325-1894