Dr. Bobby K. Yang M.D. Medical Clinic, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

43270 Issued in MN

Legal business name

DR. BOBBY K. YANG M.D. MEDICAL CLINIC, LLC

Practice address

1047 University Ave W
Suite 101
Saint Paul, MN 55104-4751

Phone

(651) 646-5452

Fax

(651) 646-5658

NPI assigned

Nov 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nou Thor

Title

Clinic Manager

Phone

(651) 646-5452

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194480000000",
    "number": "1932389897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1047 UNIVERSITY AVE W",
            "address_2": "SUITE 101",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044751",
            "telephone_number": "651-646-5452",
            "fax_number": "651-646-5658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1047 UNIVERSITY AVE W",
            "address_2": "SUITE 101",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044751",
            "telephone_number": "651-646-5452",
            "fax_number": "651-646-5658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. BOBBY K. YANG M.D. MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2007-11-08",
        "status": "A",
        "authorized_official_last_name": "THOR",
        "authorized_official_first_name": "NOU",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "651-646-5452"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "43270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "C03699",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "604682700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.