Provider Demographics
NPI:1457326332
Name:YANG, LEE-ANN (MD)
Entity Type:Individual
Prefix:
First Name:LEE-ANN
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(9608 SO. ROBERTS RD, HICKORY HILLS, IL. 60457)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-233-5333
Mailing Address - Fax:708-233-5348
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(9608 SO. ROBERTS RD, HICKORY HILLS, IL. 60457)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-233-5333
Practice Address - Fax:708-233-5348
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36091767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36091767Medicaid
IL36091767Medicaid
IL381021Medicare PIN
IL080095505 RRMedicare PIN