Healthcare Provider Details

I. General information

NPI: 1053731414
Provider Name (Legal Business Name): LUANNA YANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HAGEN DR STE 20
ROCHESTER NY
14625-2663
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-8350
  • Fax: 585-922-8355
Mailing address:
  • Phone: 585-922-8350
  • Fax: 585-922-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number297076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: