1033230834 NPI number — DR. MARK MYOUNG KYO YANG M.D.

Table of content: DR. MARK MYOUNG KYO YANG M.D. (NPI 1033230834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033230834 NPI number — DR. MARK MYOUNG KYO YANG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YANG
Provider First Name:
MARK
Provider Middle Name:
MYOUNG KYO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YANG
Provider Other First Name:
MARK
Provider Other Middle Name:
MYOUNG-KYO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033230834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 W BRIER CIR
Provider Second Line Business Mailing Address:
FRESNO
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93711-6926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-435-6938
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 W BRIER CIR
Provider Second Line Business Practice Location Address:
FRESNO
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93711-6926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-435-6938
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  AFE30324 , 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: 00A303240 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com