1699789156 NPI number — HAILIANG YANG MD

Table of content: HAILIANG YANG MD (NPI 1699789156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699789156 NPI number — HAILIANG YANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YANG
Provider First Name:
HAILIANG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1699789156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 COLUMBIA DR
Provider Second Line Business Mailing Address:
SUITE A327
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33606-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-844-4396
Provider Business Mailing Address Fax Number:
813-844-4972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 COLUMBIA DR
Provider Second Line Business Practice Location Address:
SUITE A327
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33606-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-844-4396
Provider Business Practice Location Address Fax Number:
813-844-4972
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD212145 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 239844 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: ME97818 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: ME 97818 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7952884 . This is a "AETNA GTBA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 278633800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96188 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: AF082Z . This is a "MEDICARE GTBA REASSIGN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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