Provider Demographics
NPI:1124177092
Name:YANG, TAI FUNG (MD)
Entity type:Individual
Prefix:DR
First Name:TAI
Middle Name:FUNG
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 1:980 BREVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2141
Mailing Address - Country:US
Mailing Address - Phone:321-633-9973
Mailing Address - Fax:321-633-3120
Practice Address - Street 1:980 BREVARD AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2141
Practice Address - Country:US
Practice Address - Phone:321-633-9973
Practice Address - Fax:321-633-3120
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70850208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics