Healthcare Provider Details

I. General information

NPI: 1063973212
Provider Name (Legal Business Name): HENRY TZU KUAN YANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 UNIVERSITY AVE STE 115
RIVERSIDE CA
92501-3315
US

IV. Provider business mailing address

3390 UNIVERSITY AVE STE 115
RIVERSIDE CA
92501-3315
US

V. Phone/Fax

Practice location:
  • Phone: 844-827-8000
  • Fax: 951-530-4782
Mailing address:
  • Phone: 844-827-8000
  • Fax: 951-530-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberA207469
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number324709
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number324709
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA207469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: