Individual
DR. SUSAN WILSON YANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12700 SOUTHFORK RD, SUITE 200/220, SAINT LOUIS, MO 63128-3201
(314) 543-5942
(314) 543-5947
Mailing address
12700 SOUTHFORK RD, STE 200, SAINT LOUIS, MO 63128-3201
(314) 543-5942
(314) 543-5947
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
112962
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156440016
MEDICARE PTAN
MO
Enumeration date
11/01/2006
Last updated
03/14/2017
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