Healthcare Provider Details

I. General information

NPI: 1295235935
Provider Name (Legal Business Name): YANPING GONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 BEECHDALE CRES
SASKATOON SASKATCHEWAN
S7V 0A3
CA

IV. Provider business mailing address

176 BEECHDALE CRES
SASKATOON SASKATCHEWAN
703
CA

V. Phone/Fax

Practice location:
  • Phone: 306-612-3888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35.132077
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: