Provider Demographics
NPI:1245200476
Name:YANG, REX T (MD)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:T
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 BLAZING STAR DR
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-8377
Mailing Address - Country:US
Mailing Address - Phone:773-354-3454
Mailing Address - Fax:
Practice Address - Street 1:2122 BLAZING STAR DR
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-8377
Practice Address - Country:US
Practice Address - Phone:773-354-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361145662083X0100X
OH35.0775252083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2732565Medicaid
OH2732565Medicaid