Healthcare Provider Details

I. General information

NPI: 1982654927
Provider Name (Legal Business Name): TONY T YANG M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR UCSD MEDICAL CENTER
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

5135 RENAISSANCE AVE
SAN DIEGO CA
92122-5569
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5832
  • Fax: 858-966-6733
Mailing address:
  • Phone: 858-245-3394
  • Fax: 858-966-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA63266
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA63266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: