Healthcare Provider Details

I. General information

NPI: 1548220304
Provider Name (Legal Business Name): XIAO YANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 GLADSTONE DR STE 8
PITTSBURG CA
94565-5125
US

IV. Provider business mailing address

405 PALMCREST DRIVE, APT 17
DALY CITY CA
94015
US

V. Phone/Fax

Practice location:
  • Phone: 925-301-8487
  • Fax: 925-301-8268
Mailing address:
  • Phone: 415-656-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0430644
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA94954
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA94954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: