Basic Information
| Provider Information | |||||||||
| NPI: | 1942732441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YANG | ||||||||
| FirstName: | YUETING | ||||||||
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| Mailing Information | |||||||||
| Address1: | STONY BROOK UNIVERSITY HOSPITAL | ||||||||
| Address2: | HSC T-11 / 040 | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314442020 | ||||||||
| FaxNumber: | 6314442894 | ||||||||
| Practice Location | |||||||||
| Address1: | 10675 LOVELAND MADEIRA RD | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451408965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137748220 | ||||||||
| FaxNumber: | 5137748229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2017 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.143377 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 35.143377 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2565399 | 05 | OH | MEDICAID |