Healthcare Provider Details

I. General information

NPI: 1649573171
Provider Name (Legal Business Name): PHYLLIS YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2010
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S BROAD ST UNIT 201
PHILADELPHIA PA
19145
US

IV. Provider business mailing address

1700 S BROAD ST UNIT 201
PHILADELPHIA PA
19145-2315
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-1803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD455132
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: