Healthcare Provider Details

I. General information

NPI: 1194520940
Provider Name (Legal Business Name): HSIAO-YI YANG, O.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 BREA MALL SPC 2111A
BREA CA
92821-5718
US

IV. Provider business mailing address

27 WAGON WHEEL ST
PHILLIPS RANCH CA
91766-7601
US

V. Phone/Fax

Practice location:
  • Phone: 714-674-5040
  • Fax:
Mailing address:
  • Phone: 909-767-3379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HSIAO-YI YANG
Title or Position: EMPLOYEE
Credential: OD
Phone: 909-767-3379