Provider Demographics
NPI:1528064300
Name:YANG, SUZANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
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:PO BOX 1542
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92247-1542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:78437 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2076
Practice Address - Country:US
Practice Address - Phone:760-771-9264
Practice Address - Fax:760-771-9271
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-25
Last Update Date:2016-04-11
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
CAA69687174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A696870Medicaid
CA00A696870Medicaid
CA00A696870Medicare ID - Type Unspecified