Provider Demographics
NPI:1770570152
Name:YAKIMA UROLOGY ASSOCIATES PLLC
Entity type:Organization
Organization Name:YAKIMA UROLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-249-3900
Mailing Address - Street 1:2500 RACQUET LN
Mailing Address - Street 2:STE 100
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6114
Mailing Address - Country:US
Mailing Address - Phone:509-249-3900
Mailing Address - Fax:509-573-9539
Practice Address - Street 1:2500 RACQUET LN
Practice Address - Street 2:STE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6114
Practice Address - Country:US
Practice Address - Phone:509-249-3900
Practice Address - Fax:509-573-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601650432208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7069297Medicaid
WACC9010OtherRAILROAD MEDICARE PIN
WACC9011OtherRAILROAD MEDICARE PIN
WACC9010OtherRAILROAD MEDICARE PIN