Healthcare Provider Details

I. General information

NPI: 1164165338
Provider Name (Legal Business Name): BRENDAN LEE YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/02/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 DOVE ST
NEWPORT BEACH CA
92660-2840
US

IV. Provider business mailing address

1151 DOVE ST
NEWPORT BEACH CA
92660-2840
US

V. Phone/Fax

Practice location:
  • Phone: 951-363-0200
  • Fax:
Mailing address:
  • Phone: 951-363-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: