MEDICARE: HENRY KELL 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	207W00000X	Ophthalmology Physician	MDR7A95	MO

General Provider Information

NPI Number	:	1528049509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY KELL YANG MD

Provider Business Mailing Address
First Line	:	201 W BROADWAY
Second Line	:	BLDG 4
City	:	COLUMBIA
State	:	MO
Zip	:	65203-3842
Country	:	US
Telephone Number	:	573-441-7070
Fax Number	:	573-441-2288

Provider Business Practice Location Address
First Line	:	201 W BROADWAY
Second Line	:	BLDG 4
City	:	COLUMBIA
State	:	MO
Zip	:	65203-3842
Country	:	US
Telephone Number	:	573-441-7070
Fax Number	:	573-441-2288

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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