Provider Demographics
NPI:1770547630
Name:LI, MICHAEL YANG (MD PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:YANG
Last Name:LI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13620 38TH AVE
Mailing Address - Street 2:SUITE 6F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4233
Mailing Address - Country:US
Mailing Address - Phone:718-888-9700
Mailing Address - Fax:718-888-9796
Practice Address - Street 1:136-20 38 AVE
Practice Address - Street 2:SUITE 6F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4263
Practice Address - Country:US
Practice Address - Phone:718-888-9700
Practice Address - Fax:718-888-9796
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2008-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY214851-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02213427Medicaid
NYH53898Medicare UPIN
NY06171GMedicare PIN