Provider Demographics
NPI:1083904593
Name:YANG, CHUN KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:CHUN
Middle Name:KEVIN
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHUN
Other - Middle Name:KEVIN
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:960 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1347
Mailing Address - Country:US
Mailing Address - Phone:277-821-8101
Mailing Address - Fax:727-825-1357
Practice Address - Street 1:960 7TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1347
Practice Address - Country:US
Practice Address - Phone:277-821-8101
Practice Address - Fax:727-825-1357
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1341342086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103315300Medicaid