MEDICARE: AMY J YANG M.D., LLC

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	2084P0800X	Psychiatry Physician	036133637	IL

General Provider Information

NPI Number	:	1477081230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY J YANG M.D., LLC

Provider Business Mailing Address
First Line	:	1525 E 53RD ST STE 933
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4572
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 E 53RD ST STE 933
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4572
Country	:	US
Telephone Number	:	773-217-9266
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMY YANG
Credential	:	MD
Telephone Number	:	347-673-9210

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	05/24/2017

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