Provider Demographics
NPI:1760126064
Name:YANG, BOWEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BOWEN
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270-05 76TH AVE RESEARCH BUILDING C-LEVEL RM039AB
Mailing Address - Street 2:OFFICE OF SURGICAL EDUCATION
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:718-470-4475
Mailing Address - Fax:718-962-2239
Practice Address - Street 1:270-05 76TH AVE RESEARCH BUILDING C-LEVEL RM039AB
Practice Address - Street 2:OFFICE OF SURGICAL EDUCATION
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:718-470-4475
Practice Address - Fax:718-962-2239
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program