Healthcare Provider Details

I. General information

NPI: 1356980841
Provider Name (Legal Business Name): HSIAO-YI YANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
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 TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number34477TLG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34477TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: