Provider Demographics
NPI:1528144961
Name:YANG, STAN CHI-CHUAN (OD)
Entity type:Individual
Prefix:
First Name:STAN
Middle Name:CHI-CHUAN
Last Name:YANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:CHI-CHUAN
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:11320 MING AVE
Mailing Address - Street 2:STE 360
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1304
Mailing Address - Country:US
Mailing Address - Phone:626-961-5290
Mailing Address - Fax:
Practice Address - Street 1:18000 STUDEBAKER RD
Practice Address - Street 2:SUITE 505
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2679
Practice Address - Country:US
Practice Address - Phone:562-402-5823
Practice Address - Fax:562-402-5884
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist