Provider Demographics
NPI:1174559280
Name:YANG, HEE KON (MD)
Entity type:Individual
Prefix:DR
First Name:HEE
Middle Name:KON
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 HUDSON TERRACE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:201-567-7747
Mailing Address - Fax:201-567-3916
Practice Address - Street 1:464 HUDSON TERRACE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632
Practice Address - Country:US
Practice Address - Phone:201-567-7747
Practice Address - Fax:201-567-3916
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01605018Medicaid
NYF99369Medicare UPIN
NY01605018Medicaid