Healthcare Provider Details

I. General information

NPI: 1659747954
Provider Name (Legal Business Name): KEE IN YANG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6334 MISSION BLVD
RIVERSIDE CA
92509-4123
US

IV. Provider business mailing address

6334 MISSION BLVD
RIVERSIDE CA
92509-4123
US

V. Phone/Fax

Practice location:
  • Phone: 951-248-9113
  • Fax: 951-248-9115
Mailing address:
  • Phone: 951-248-9113
  • Fax: 951-248-9115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA38547
License Number StateCA

VIII. Authorized Official

Name: DR. KEE I YANG
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 951-248-9113