Provider Demographics
NPI:1578551032
Name:SANGWAN, YASH PAL (MD)
Entity Type:Individual
Prefix:DR
First Name:YASH
Middle Name:PAL
Last Name:SANGWAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1411 S 14TH ST
Mailing Address - Street 2:STE C
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3031
Mailing Address - Country:US
Mailing Address - Phone:904-261-6209
Mailing Address - Fax:904-261-0732
Practice Address - Street 1:1411 S 14TH ST
Practice Address - Street 2:STE C
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3031
Practice Address - Country:US
Practice Address - Phone:904-261-6209
Practice Address - Fax:904-261-0732
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2010-06-13
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Provider Licenses
StateLicense IDTaxonomies
FL78773208C00000X
FLME78773208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2938AMedicare UPIN