Provider Demographics
NPI:1275631285
Name:YANG, SUNG K (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:K
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:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7680
Mailing Address - Fax:719-595-7687
Practice Address - Street 1:1600 N. GRAND AVE.
Practice Address - Street 2:STE 150
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2749
Practice Address - Country:US
Practice Address - Phone:719-595-7680
Practice Address - Fax:719-595-7687
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056521207RG0100X
CODR.0061669207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3364901Medicaid
CO9000170136Medicaid
MI4340978Medicaid
MI4257370Medicaid
MI100F37143OtherBCBS AND BCN
MI4257370Medicaid