Healthcare Provider Details

I. General information

NPI: 1154974269
Provider Name (Legal Business Name): YANKI OKUDUCU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSGEN HOSPITAL 55 FRUIT STREET
BOSTON MA
02114
US

IV. Provider business mailing address

2 HAWTHORNE PL APT 4G
BOSTON MA
02114-2305
US

V. Phone/Fax

Practice location:
  • Phone: 917-392-6068
  • Fax:
Mailing address:
  • Phone: 917-392-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number295158
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: