Healthcare Provider Details

I. General information

NPI: 1811636178
Provider Name (Legal Business Name): ALEX W YANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER RD N
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

602 BAYSIDE CT
SOUTH AMBOY NJ
08879-1993
US

V. Phone/Fax

Practice location:
  • Phone: 732-325-4688
  • Fax:
Mailing address:
  • Phone: 732-325-4688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101280706
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: