Provider Demographics
NPI:1730135138
Name:YUMANG, EMMANUEL C (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:C
Last Name:YUMANG
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 1:73 THOMPSON POYNTER ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2050
Mailing Address - Country:US
Mailing Address - Phone:606-877-1446
Mailing Address - Fax:606-877-1285
Practice Address - Street 1:73 THOMPSON POYNTER ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2050
Practice Address - Country:US
Practice Address - Phone:606-877-1446
Practice Address - Fax:606-877-1285
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35026207P00000X, 207R00000X, 207RG0300X, 208M00000X
KY1000633261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10807024OtherCAQH
KY31001001Medicaid
KY64004294Medicaid
KY31001001Medicaid