Provider Demographics
NPI:1144864711
Name:YANG, KA DEY (PA)
Entity type:Individual
Prefix:
First Name:KA DEY
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 DESOTO ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3605
Mailing Address - Country:US
Mailing Address - Phone:920-544-1280
Mailing Address - Fax:
Practice Address - Street 1:444 E BOSTON POST RD STE 201
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3704
Practice Address - Country:US
Practice Address - Phone:914-834-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13251363A00000X
NY028626-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant