Provider Demographics
NPI:1659317907
Name:YANG, SUSAN H (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:211 N MERAMEC AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3745
Mailing Address - Country:US
Mailing Address - Phone:314-863-4200
Mailing Address - Fax:314-863-3570
Practice Address - Street 1:211 N MERAMEC AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3745
Practice Address - Country:US
Practice Address - Phone:314-863-4200
Practice Address - Fax:314-863-3570
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO2001008748207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H36120Medicare UPIN