Provider Demographics
NPI:1841243003
Name:SHAN, YANG (MD)
Entity Type:Individual
Prefix:
First Name:YANG
Middle Name:
Last Name:SHAN
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 1:400 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2414
Mailing Address - Country:US
Mailing Address - Phone:267-205-3177
Mailing Address - Fax:
Practice Address - Street 1:400 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2414
Practice Address - Country:US
Practice Address - Phone:267-205-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4216272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD421627OtherLICENSE
PA0019548740001Medicaid
PA0019548740001Medicaid
PAH89813Medicare UPIN