Provider Demographics
NPI:1669479580
Name:YANG, CHARLOTTE ZHONG (M D)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:ZHONG
Last Name:YANG
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COBBLESTONE PL
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3547
Mailing Address - Country:US
Mailing Address - Phone:989-667-6780
Mailing Address - Fax:989-667-6218
Practice Address - Street 1:4817 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2839
Practice Address - Country:US
Practice Address - Phone:989-667-6780
Practice Address - Fax:989-667-6218
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2014-01-21
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MI4301076817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4289392Medicaid
MIH06290Medicare UPIN
MI0N25880Medicare ID - Type Unspecified