MEDICARE: JOHNNY YANG

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	347D00000X	Train		NY

General Provider Information

NPI Number	:	1457114068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNY YANG

Provider Business Mailing Address
First Line	:	1468 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6508
Country	:	US
Telephone Number	:	212-241-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6508
Country	:	US
Telephone Number	:	212-241-6500
Fax Number	:

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

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	06/05/2026

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Directions to “ JOHNNY YANG ” Practice Location

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