MEDICARE: YUE-SHAN LEIF YANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	25MA10641100	NJ
2	208100000X	Physical Medicine & Rehabilitation Physician	298443	NY
3	208100000X	Physical Medicine & Rehabilitation Physician	A168814	CA

General Provider Information

NPI Number	:	1336534668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUE-SHAN LEIF YANG MD

Provider Business Mailing Address
First Line	:	103 RIVER RD STE 101
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E STE 303
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2006
Country	:	US
Telephone Number	:	424-363-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	08/18/2020

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