Healthcare Provider Details

I. General information

NPI: 1245200476
Provider Name (Legal Business Name): REX T YANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 01/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 BLAZING STAR DR
TIPP CITY OH
45371-8377
US

IV. Provider business mailing address

2122 BLAZING STAR DR
TIPP CITY OH
45371-8377
US

V. Phone/Fax

Practice location:
  • Phone: 773-354-3454
  • Fax:
Mailing address:
  • Phone: 773-354-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number036114566
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35.077525
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: