Provider Demographics
NPI:1588749600
Name:YANG, ERIC S (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:S
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 1:23430 HAWTHORNE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4730
Mailing Address - Country:US
Mailing Address - Phone:310-784-5880
Mailing Address - Fax:310-325-3117
Practice Address - Street 1:23430 HAWTHORNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4730
Practice Address - Country:US
Practice Address - Phone:310-784-5880
Practice Address - Fax:310-325-3117
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89181207RI0200X, 208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA6447OtherRRM
CAM050376OtherGROUP
CAWA89181AMedicare PIN
CADA6447OtherRRM