MEDICARE: MISS YANG YANG PHARM.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	71452	CA

General Provider Information

NPI Number	:	1548663859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS YANG YANG PHARM.D

Provider Business Mailing Address
First Line	:	49961 CALLE ESTRELLA
Second Line	:
City	:	LA QUINTA
State	:	CA
Zip	:	92253-2604
Country	:	US
Telephone Number	:	507-779-1552
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 CARNEGIE DR
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3588
Country	:	US
Telephone Number	:	714-671-3161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2014
Last Update Date	:	09/30/2014

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