Healthcare Provider Details

I. General information

NPI: 1245443225
Provider Name (Legal Business Name): YVONNE MARIE DEE YANG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 655
ROCHESTER NY
14642-8655
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 655
ROCHESTER NY
14642-8655
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-9555
  • Fax: 585-785-8234
Mailing address:
  • Phone: 585-275-9555
  • Fax: 585-785-8234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number58.001846
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: