MEDICARE: MARCOS YANG, M. D. INC.

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	207Q00000X	Family Medicine Physician	A49035	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D0548628	OTHER	CA	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982908463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCOS YANG, M. D. INC.

Provider Business Mailing Address
First Line	:	310 TEJON PL
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-1204
Country	:	US
Telephone Number	:	310-375-2403
Fax Number	:	310-375-9652

Provider Business Practice Location Address
First Line	:	310 TEJON PL
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-1204
Country	:	US
Telephone Number	:	310-375-2403
Fax Number	:	310-375-9652

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARCOS Y YANG
Credential	:	M.D.
Telephone Number	:	310-375-2403

Provider Enumeration Date	:	12/27/2010
Last Update Date	:	12/27/2010

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