Healthcare Provider Details

I. General information

NPI: 1588840870
Provider Name (Legal Business Name): TINA YANG MD MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N OAK KNOLL AVE SUITE 100
PASADENA CA
91101-5638
US

IV. Provider business mailing address

PO BOX 800817
SANTA CLARITA CA
91380-0817
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-3000
  • Fax:
Mailing address:
  • Phone: 661-295-0859
  • Fax: 661-295-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA63620
License Number StateCA

VIII. Authorized Official

Name: DR. TINA YANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-795-3000