Provider Demographics
NPI:1477968873
Name:XIA, YANG (OD)
Entity Type:Individual
Prefix:
First Name:YANG
Middle Name:
Last Name:XIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201-07 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1005
Mailing Address - Country:US
Mailing Address - Phone:917-635-7677
Mailing Address - Fax:
Practice Address - Street 1:135-12 ROOSEVELT AVENUE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-886-8637
Practice Address - Fax:718-886-8607
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008150-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist