Provider Demographics
NPI:1821034356
Name:YEUNG, ANTHONY T
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:T
Last Name:YEUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 E MYRTLE AVE SUITE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5514
Mailing Address - Country:US
Mailing Address - Phone:602-944-2900
Mailing Address - Fax:602-944-0064
Practice Address - Street 1:1635 E MYRTLE AVE
Practice Address - Street 2:STE 400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5556
Practice Address - Country:US
Practice Address - Phone:602-944-2900
Practice Address - Fax:602-944-0064
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71422Medicare ID - Type Unspecified