1902923766 NPI number — DR. YANG'S FAMILY CARE

Table of content: (NPI 1902923766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902923766 NPI number — DR. YANG'S FAMILY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. YANG'S FAMILY CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902923766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10201 MISSION GORGE RD
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
SANTEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92071-3026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-596-4963
Provider Business Mailing Address Fax Number:
619-596-4965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10201 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-596-4963
Provider Business Practice Location Address Fax Number:
619-596-4963
Provider Enumeration Date:
03/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YANG
Authorized Official First Name:
THERESE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
619-596-4963

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G64469 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0089500 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659339620 . This is a "DR. YANG'S NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AR524Z . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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