Basic Information
Provider Information | |||||||||
NPI: | 1013987841 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YANG | ||||||||
FirstName: | TING-WEI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3600 LIND AVE SW | ||||||||
Address2: | SUITE 100 ATTN CREDENTIALING | ||||||||
City: | RENTON | ||||||||
State: | WA | ||||||||
PostalCode: | 98057 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4256902715 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4011 TALBOT RD S STE 500 | ||||||||
Address2: |   | ||||||||
City: | RENTON | ||||||||
State: | WA | ||||||||
PostalCode: | 980555782 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4256903482 | ||||||||
FaxNumber: | 4296909082 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/24/2006 | ||||||||
LastUpdateDate: | 03/18/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/18/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD60653178 | WA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | 0101222166 | VA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RC0000X | 0101222166 | VA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | G8984952 | 01 | WA | MEDICARE W VALLEY MEDICAL GROUP - RENTON | OTHER | 2107808 | 05 | WA |   | MEDICAID |