Provider Demographics
NPI:1417937780
Name:OUYANG, DAVID TUNG (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TUNG
Last Name:OUYANG
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 1:85 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1542
Mailing Address - Country:US
Mailing Address - Phone:607-753-3797
Mailing Address - Fax:
Practice Address - Street 1:4038 WEST RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1842
Practice Address - Country:US
Practice Address - Phone:607-758-3008
Practice Address - Fax:607-758-3019
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199497207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00533275Medicaid
NH30204814Medicaid
NY03401741Medicaid
NH30204814Medicaid
NY00533275Medicaid