Provider Demographics
NPI:1689674483
Name:YANG, THEODORE KUO-CHUN (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:KUO-CHUN
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:PO BOX 8399
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-8399
Mailing Address - Country:US
Mailing Address - Phone:281-364-1707
Mailing Address - Fax:281-364-0028
Practice Address - Street 1:25511 BUDDE RD
Practice Address - Street 2:SUITE 1201
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2080
Practice Address - Country:US
Practice Address - Phone:281-364-1707
Practice Address - Fax:281-364-0028
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ60532085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117273605Medicaid
TX117273606Medicaid
TX00251TOtherGROUP MEDICARE
TX159064801OtherGROUP MEDICAID
G48895Medicare UPIN
TX117273606Medicaid
TX159064801OtherGROUP MEDICAID