Provider Demographics
NPI:1154741015
Name:YANG, XIAOYUN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:XIAOYUN
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 SAINT ANTOINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5147
Mailing Address - Fax:
Practice Address - Street 1:233 N HOUSTON RD STE 140E
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3023
Practice Address - Country:US
Practice Address - Phone:478-975-6880
Practice Address - Fax:478-975-6869
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA83513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program