MEDICARE: THEODORE KUO-CHUN 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	2085R0001X	Radiation Oncology Physician	J6053	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	00251T	OTHER	TX	GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689674483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE KUO-CHUN YANG MD

Provider Business Mailing Address
First Line	:	PO BOX 8399
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77387-8399
Country	:	US
Telephone Number	:	281-364-1707
Fax Number	:	281-364-0028

Provider Business Practice Location Address
First Line	:	25511 BUDDE RD
Second Line	:	SUITE 1201
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-2080
Country	:	US
Telephone Number	:	281-364-1707
Fax Number	:	281-364-0028

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	09/15/2016

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