Provider Demographics
NPI:1346358371
Name:YANG, PAOKOU MARCUS (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAOKOU
Middle Name:MARCUS
Last Name:YANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:PAOKOU
Other - Middle Name:MARCUS
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:1504 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1622
Mailing Address - Country:US
Mailing Address - Phone:651-771-2513
Mailing Address - Fax:651-771-2514
Practice Address - Street 1:1504 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-1622
Practice Address - Country:US
Practice Address - Phone:651-771-2513
Practice Address - Fax:651-771-2514
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN681213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU90533Medicare UPIN
MN4762260001Medicare NSC