Healthcare Provider Details

I. General information

NPI: 1386384063
Provider Name (Legal Business Name): GUANG YANG MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

3535 MONROE AVE UNIT 21
SAN DIEGO CA
92116-3589
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6308
  • Fax:
Mailing address:
  • Phone: 408-334-5197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA207058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: