Provider Demographics
NPI:1831177922
Name:YANG, KEYI (MD)
Entity type:Individual
Prefix:DR
First Name:KEYI
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5300
Mailing Address - Country:US
Mailing Address - Phone:253-573-0460
Mailing Address - Fax:
Practice Address - Street 1:1708 SO. YAKIMA AVE
Practice Address - Street 2:STE 118
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-573-0460
Practice Address - Fax:253-573-0461
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000399612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH78542Medicare UPIN
WAGAB39891Medicare PIN