Provider Demographics
NPI:1427255454
Name:YANG, DARICE T (MD)
Entity type:Individual
Prefix:
First Name:DARICE
Middle Name:T
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E CALIFORNIA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3954
Mailing Address - Country:US
Mailing Address - Phone:626-397-8323
Mailing Address - Fax:626-568-3127
Practice Address - Street 1:55 E CALIFORNIA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3954
Practice Address - Country:US
Practice Address - Phone:626-397-8323
Practice Address - Fax:626-568-3127
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93423207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A934230Medicaid
DJ542ZMedicare PIN
DJ542YMedicare PIN