Provider Demographics
NPI:1750304580
Name:YANG, BOBBY KHUE (MD)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:KHUE
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 UNIVERSITY AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4751
Mailing Address - Country:US
Mailing Address - Phone:651-646-5452
Mailing Address - Fax:651-646-5658
Practice Address - Street 1:1047 UNIVERSITY AVE W STE 101
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4751
Practice Address - Country:US
Practice Address - Phone:651-646-5452
Practice Address - Fax:651-646-5658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN43270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH34168Medicare UPIN