Organization
DR. BOBBY K. YANG M.D. MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NOU THOR (CLINIC MANAGER)
(651) 646-5452
Entity
Organization
Contact information
Practice address
1047 UNIVERSITY AVE W, SUITE 101, SAINT PAUL, MN 55104-4751
(651) 646-5452
(651) 646-5658
Mailing address
1047 UNIVERSITY AVE W, SUITE 101, SAINT PAUL, MN 55104-4751
(651) 646-5452
(651) 646-5658
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
43270
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
604682700
—
MN
01
—
C03699
MEDICARE GROUP
MN
Enumeration date
11/08/2007
Last updated
11/08/2007
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