Healthcare Provider Details

I. General information

NPI: 1184871345
Provider Name (Legal Business Name): PETER YANG MA MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W DUARTE RD STE 208
ARCADIA CA
91007-7675
US

IV. Provider business mailing address

612 W DUARTE RD SUITE 505
ARCADIA CA
91007
US

V. Phone/Fax

Practice location:
  • Phone: 626-294-9978
  • Fax: 626-294-9526
Mailing address:
  • Phone: 626-294-9978
  • Fax: 626-294-9526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA53050
License Number StateCA

VIII. Authorized Official

Name: DR. YANG MA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-294-9978