Provider Demographics
NPI:1114214178
Name:YANG, MINDY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:LEE
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MINDY
Other - Middle Name:YANG
Other - Last Name:LICURSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-9724
Mailing Address - Fax:215-707-9389
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:215-707-7237
Practice Address - Fax:215-707-9389
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4508682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology