Healthcare Provider Details

I. General information

NPI: 1902012180
Provider Name (Legal Business Name): AMY C YANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SW GAINES ST
PORTLAND OR
97239-2901
US

IV. Provider business mailing address

707 SW GAINES ST
PORTLAND OR
97239-2901
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-7859
  • Fax: 503-494-4447
Mailing address:
  • Phone: 503-494-7859
  • Fax: 503-494-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number246735
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number246735
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD185690
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD185690
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: