Basic Information
Provider Information
NPI: 1033559646
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YANG
FirstName: SHELLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 155 S. MADISON ST
Address2: STE. 226
City: DENVER
State: CO
PostalCode: 80209
CountryCode: US
TelephoneNumber: 3033227789
FaxNumber: 3033220221
Practice Location
Address1: 155 S MADISON ST STE 226
Address2:  
City: DENVER
State: CO
PostalCode: 802093013
CountryCode: US
TelephoneNumber: 3033227789
FaxNumber: 3033220221
Other Information
ProviderEnumerationDate: 06/27/2013
LastUpdateDate: 06/20/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000XDR.0058536COY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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