Provider Demographics
NPI:1518993229
Name:YANG, RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:YANG
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 1:1650 LILIHA ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3169
Mailing Address - Country:US
Mailing Address - Phone:808-376-2100
Mailing Address - Fax:808-465-3200
Practice Address - Street 1:1650 LILIHA ST STE 101
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3169
Practice Address - Country:US
Practice Address - Phone:808-376-2100
Practice Address - Fax:808-465-3200
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-121941207RG0100X
HI16824207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A462490197OtherCAL OPTIMA
CA00A462490Medicaid
IL036121941Medicaid
CACE1617OtherGROUP RAILROAD MEDICARE
CAGR0016910OtherGROUP MEDICAID PIN
CA00A462490OtherBLUE SHIELD
CA110069446OtherRAILROAD MEDICARE
CA1356390009OtherGROUP NPI
CAW11675OtherGROUP MEDICARE PIN
CAC23837Medicare UPIN
CA00A462490Medicaid
CACE1617OtherGROUP RAILROAD MEDICARE