# MILWAUKEE INDONESIA MEDICAL CLINIC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Indonesia Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366814162
- **Authorized official:** HERR YANG (PRESIDENT)
- **Authorized official phone:** (414) 397-1654

## Contact information

- **Practice address:** 6300 N 76TH ST STE 250, MILWAUKEE, WI 53218-1208
- **Practice address phone:** (414) 446-4660
- **Mailing address:** 6300 N 76TH ST STE 250, MILWAUKEE, WI 53218-1208
- **Mailing address phone:** (414) 446-4660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 183500000X | Pharmacist | — | NULL | — |
| 183500000X | Pharmacist | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/20/2015
- **Last updated:** 11/14/2016