Healthcare Provider Details

I. General information

NPI: 1043284979
Provider Name (Legal Business Name): ALISA YANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST SUITE 208
PASADENA CA
91105-3045
US

IV. Provider business mailing address

13640 ROSCOE BLVD
PANORAMA CITY CA
91402-3904
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-2166
  • Fax: 626-795-0740
Mailing address:
  • Phone: 818-375-3735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA80019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: