Healthcare Provider Details

I. General information

NPI: 1366435638
Provider Name (Legal Business Name): CHANGGAO YANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 OLD RANCH PKWY SUITE 430
SEAL BEACH CA
90740-2765
US

IV. Provider business mailing address

3030 OLD RANCH PKWY STE 430
SEAL BEACH CA
90740-2760
US

V. Phone/Fax

Practice location:
  • Phone: 562-799-8900
  • Fax: 562-799-8901
Mailing address:
  • Phone: 562-799-8900
  • Fax: 562-799-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA062281
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberA062281
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA062281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: