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General NPI Number Information
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NPI Number | 1346503539
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Entity Type | Organization
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Legal Business Name | Y T PRIMARY CARE PC
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 1603 PATHWAY DR
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City | NAPERVILLE
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State | IL
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Zip | 60565-9308
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Country | US
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Telephone | 630-357-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 1603 PATHWAY DR.
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City | NAPERVILLE
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State | IL
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Zip | 60565
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | XIANG YANG
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Credential |
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Telephone | 630-357-5410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085002931
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License Number State | IL
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