Healthcare Provider Details

I. General information

NPI: 1215873377
Provider Name (Legal Business Name): WENXI YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIBYL YANG

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4067 MIRAMAR ST # 5435
LA JOLLA CA
92037-1329
US

IV. Provider business mailing address

4067 MIRAMAR ST # 5435
LA JOLLA CA
92037-1329
US

V. Phone/Fax

Practice location:
  • Phone: 314-437-2352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: