1124127519 NPI number — YONGQI YONG, MD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124127519 NPI number — YONGQI YONG, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YONGQI YONG, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124127519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 740427
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77274-0427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-779-8148
Provider Business Mailing Address Fax Number:
281-313-0718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9440 BELLAIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE #102
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036-4557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-779-8148
Provider Business Practice Location Address Fax Number:
713-779-4148
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YONG
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Y.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
713-779-8148

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  K8588 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150900201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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