Healthcare Provider Details

I. General information

NPI: 1255569562
Provider Name (Legal Business Name): SAM YANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WORNALL RD ANESTHESIOLOGY
KANSAS CITY MO
64111-3220
US

IV. Provider business mailing address

PO BOX 504407
SAINT LOUIS MO
63150-4407
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-7940
  • Fax:
Mailing address:
  • Phone: 816-932-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2013018940
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number2013018940
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: