Provider Demographics
NPI:1487840872
Name:YI, EDWARD KWANG (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:KWANG
Last Name:YI
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 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 S MANNING BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1707
Practice Address - Country:US
Practice Address - Phone:518-525-1401
Practice Address - Fax:518-525-1200
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI116312085R0202X
IN01074532A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1487840872Medicaid
IN201255740Medicaid
OH01102011Medicaid
MI1487840872Medicaid
INP01500304Medicare PIN
OH01102011Medicaid
HI201243800OtherUS LABOR DEPT
HI1487840872Medicaid