=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215187471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED MEDICAL CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2008
-----------------------------------------------------
Last Update Date | 03/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 491 UNIVERSITY AVE W SUITE# B
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55103-1936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-771-5778
-----------------------------------------------------
Fax | 651-771-5775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 491 UNIVERSITY AVE W SUITE# B
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55103-1936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-771-5778
-----------------------------------------------------
Fax | 651-771-5775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. PETER THAI YANG
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 651-771-5778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 44150
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------