Provider Demographics
NPI:1629165741
Name:YANG, EDMUND YI-BIN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:YI-BIN
Last Name:YANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6814 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4661
Mailing Address - Country:US
Mailing Address - Phone:314-537-5298
Mailing Address - Fax:
Practice Address - Street 1:6814 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-4661
Practice Address - Country:US
Practice Address - Phone:314-537-5298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1290942086S0120X
MO20090013142086S0120X
TNMD378122086S0120X
IN01081595A2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92128Medicare UPIN