Provider Demographics
NPI:1164198644
Name:YANG, KONG MENG P (NP)
Entity Type:Individual
Prefix:
First Name:KONG MENG
Middle Name:P
Last Name:YANG
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:920-458-4010
Mailing Address - Fax:920-459-1137
Practice Address - Street 1:1813 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-6125
Practice Address - Country:US
Practice Address - Phone:920-458-4010
Practice Address - Fax:920-459-1137
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI11187363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100181223Medicaid