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General NPI Number Information
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NPI Number | 1851572523
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Entity Type | Organization
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Legal Business Name | YAKIMA UROLOGY ASSOCIATES,PLLC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 100 E JACKSON AVE STE 105
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City | ELLENSBURG
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State | WA
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Zip | 98926-3692
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Country | US
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Telephone | 509-249-3900
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Fax | 509-573-9539
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Provider Business Mailing Address
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Address Line | 2500 RACQUET LN STE 100
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City | YAKIMA
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State | WA
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Zip | 98902-6114
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Country | US
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Telephone | 509-249-3900
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Fax | 509-573-9539
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RICHARD M CHANG
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Credential |
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Telephone | 509-249-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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