=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619159910
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENNETT C. YANG, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2007
-----------------------------------------------------
Last Update Date | 11/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3203 TOWER OAKS BLVD STE 200
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-4258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-656-6398
-----------------------------------------------------
Fax | 301-754-2503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3203 TOWER OAKS BLVD STE 200
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-4258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-656-6398
-----------------------------------------------------
Fax | 301-754-2503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | ANGELA SHEMUHA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-656-6398
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | D54936
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------