Provider Demographics
NPI:1770539504
Name:YANG, LUGUANG (MD)
Entity type:Individual
Prefix:DR
First Name:LUGUANG
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3263
Mailing Address - Country:US
Mailing Address - Phone:718-686-1733
Mailing Address - Fax:718-686-1723
Practice Address - Street 1:824 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3263
Practice Address - Country:US
Practice Address - Phone:718-686-1733
Practice Address - Fax:718-686-1723
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204326225400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1888811Medicaid
NY20Z521Medicare ID - Type Unspecified
NY1888811Medicaid
NY20Z522Medicare ID - Type Unspecified