Healthcare Provider Details

I. General information

NPI: 1528049509
Provider Name (Legal Business Name): HENRY KELL YANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W BROADWAY BLDG 4
COLUMBIA MO
65203-3842
US

IV. Provider business mailing address

201 W BROADWAY BLDG 4
COLUMBIA MO
65203-3842
US

V. Phone/Fax

Practice location:
  • Phone: 573-441-7070
  • Fax: 573-441-2288
Mailing address:
  • Phone: 573-441-7070
  • Fax: 573-441-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMDR7A95
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: