Provider Demographics
NPI:1366435638
Name:YANG, CHANGGAO (MD)
Entity type:Individual
Prefix:MR
First Name:CHANGGAO
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 OLD RANCH PKWY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2765
Mailing Address - Country:US
Mailing Address - Phone:562-799-8900
Mailing Address - Fax:562-799-8901
Practice Address - Street 1:3030 OLD RANCH PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2765
Practice Address - Country:US
Practice Address - Phone:562-799-8900
Practice Address - Fax:562-799-8901
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAG2281207ZD0900X, 207ZH0000X, 207ZP0007X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D1012129OtherCLIA
CA00A62281Medicaid
05D1012129OtherCLIA
HW16573Medicare ID - Type Unspecified
CA00A62281Medicaid