Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 018241 | MA |
Y | 213EG0000X | General Practice | 018241 | MA |
NPI | 1992999650 |
---|---|
Provider Name | Wayne B. Yong |
First Address | Boston, MA 02110-3802 |
Second Address | Boston, MA 02110-3802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 05/09/2007 |