Healthcare Provider Details

I. General information

NPI: 1417559915
Provider Name (Legal Business Name): RYAN W YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5018
US

IV. Provider business mailing address

19600 E ROSS ST
TAHLEQUAH OK
74464-0545
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2316
  • Fax:
Mailing address:
  • Phone: 539-234-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43370
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: