Healthcare Provider Details

I. General information

NPI: 1629877113
Provider Name (Legal Business Name): SUSAN YANG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PARNELL PL
COSTA MESA CA
92626-2737
US

IV. Provider business mailing address

1201 PARNELL PL
COSTA MESA CA
92626-2737
US

V. Phone/Fax

Practice location:
  • Phone: 214-597-5544
  • Fax:
Mailing address:
  • Phone: 214-597-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN YANG
Title or Position: CEO
Credential:
Phone: 214-597-5544