Healthcare Provider Details

I. General information

NPI: 1982651998
Provider Name (Legal Business Name): ANGELITO F YANGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 8TH AVE SUITE 500
FORT WORTH TX
76104-4124
US

IV. Provider business mailing address

1420 VICEROY DR
DALLAS TX
75235-2208
US

V. Phone/Fax

Practice location:
  • Phone: 214-358-2300
  • Fax: 214-366-6127
Mailing address:
  • Phone: 214-358-2300
  • Fax: 214-366-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberN4859
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: