=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568432615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WEI YANG
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2006
-----------------------------------------------------
Last Update Date | 11/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | NORTHEAST IOWA PATHOLOGY ASSOCIATES, PC 1825 LOGAN AVENUE
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-235-3679
-----------------------------------------------------
Fax | 319-233-0722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 957076
-----------------------------------------------------
City | ST. LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63195-7076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-817-7842
-----------------------------------------------------
Fax | 866-379-7504
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 35459
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------