Provider Demographics
NPI:1114017092
Name:YANG, BYOUNG WOO (MD)
Entity Type:Individual
Prefix:DR
First Name:BYOUNG
Middle Name:WOO
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BYOUNG-WOO
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:34 S BROADWAY STE 114
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4432
Mailing Address - Country:US
Mailing Address - Phone:914-422-5712
Mailing Address - Fax:914-422-5714
Practice Address - Street 1:34 S BROADWAY STE 114
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4432
Practice Address - Country:US
Practice Address - Phone:914-422-5712
Practice Address - Fax:914-422-5714
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017783207R00000X
PAMD430042207R00000X
NY2648372083P0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03523080Medicaid
NY264837OtherSTATE MEDICAL LICENSE
ME43463399Medicaid
PAMD430042OtherSTATE MEDICAL LICENSE
MD430042Medicare UPIN
ME43463399Medicaid
NY264837OtherSTATE MEDICAL LICENSE