Healthcare Provider Details

I. General information

NPI: 1831196807
Provider Name (Legal Business Name): HAZEL YANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

2025 CARTER AVE
ASHLAND KY
41101-7731
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number29156
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: