Healthcare Provider Details

I. General information

NPI: 1841123965
Provider Name (Legal Business Name): AN YANG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13652 CANTARA ST
PANORAMA CITY CA
91402-5423
US

IV. Provider business mailing address

1898 VINE ST UNIT A
ALHAMBRA CA
91801-1835
US

V. Phone/Fax

Practice location:
  • Phone: 866-362-4939
  • Fax:
Mailing address:
  • Phone: 479-222-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: