Provider Demographics
NPI:1659754000
Name:YANG, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HOUBOLT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8305
Mailing Address - Country:US
Mailing Address - Phone:815-553-0990
Mailing Address - Fax:815-553-0991
Practice Address - Street 1:350 HOUBOLT RD STE 104
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8305
Practice Address - Country:US
Practice Address - Phone:815-553-0990
Practice Address - Fax:815-553-0991
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135000895213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery