Provider Demographics
NPI:1396031191
Name:YANG, HONG (MD)
Entity type:Individual
Prefix:
First Name:HONG
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 1:29 MAPLE RUN DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2840
Mailing Address - Country:US
Mailing Address - Phone:636-544-5727
Mailing Address - Fax:
Practice Address - Street 1:4235 MAIN ST STE 3C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3969
Practice Address - Country:US
Practice Address - Phone:718-673-2318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011013276207R00000X
MN76167207RN0300X
IN01074728A208M00000X, 207R00000X
NY311574207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01074728BOtherCSR
IN201275100Medicaid
IN01074728AOtherSTATE LICENSE
IN01074728BOtherCSR