Provider Demographics
NPI:1447286323
Name:YANG, LI-MIN (MD)
Entity type:Individual
Prefix:
First Name:LI-MIN
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22116 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3641
Mailing Address - Country:US
Mailing Address - Phone:718-465-5888
Mailing Address - Fax:718-465-5889
Practice Address - Street 1:22116 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-3641
Practice Address - Country:US
Practice Address - Phone:718-465-5888
Practice Address - Fax:718-465-5889
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02824739Medicaid