Healthcare Provider Details

I. General information

NPI: 1982665444
Provider Name (Legal Business Name): YUNG FENG FANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S 7TH AVE SUITE A
BARSTOW CA
92311
US

IV. Provider business mailing address

121 S 7TH AVE SUITE A
BARSTOW CA
92311
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-2181
  • Fax: 760-256-2020
Mailing address:
  • Phone: 760-256-2181
  • Fax: 760-256-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA30721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: