Provider Demographics
NPI:1780128017
Name:GONG, YANG X (D AC)
Entity type:Individual
Prefix:DR
First Name:YANG
Middle Name:
Last Name:GONG
Suffix:X
Gender:F
Credentials:D AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S BUCKEYE ST
Mailing Address - Street 2:23
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-3302
Mailing Address - Country:US
Mailing Address - Phone:620-363-1685
Mailing Address - Fax:
Practice Address - Street 1:204 S BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3302
Practice Address - Country:US
Practice Address - Phone:620-363-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist