Provider Demographics
NPI:1902923766
Name:DR. YANG'S FAMILY CARE
Entity type:Organization
Organization Name:DR. YANG'S FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:H
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-596-4963
Mailing Address - Street 1:10201 MISSION GORGE RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3026
Mailing Address - Country:US
Mailing Address - Phone:619-596-4963
Mailing Address - Fax:619-596-4965
Practice Address - Street 1:10201 MISSION GORGE RD
Practice Address - Street 2:SUITE H
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3026
Practice Address - Country:US
Practice Address - Phone:619-596-4963
Practice Address - Fax:619-596-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089500Medicaid
CA1659339620OtherDR. YANG'S NPI
CAAR524ZOtherPTAN
CAW15129Medicare ID - Type UnspecifiedGROUP
CA1659339620OtherDR. YANG'S NPI
CAF17140Medicare UPIN
CAA25324Medicare UPIN