Healthcare Provider Details

I. General information

NPI: 1053806307
Provider Name (Legal Business Name): HARRISON HANG YANG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2056 WESTMINSTER MALL
WESTMINSTER CA
92683-4947
US

IV. Provider business mailing address

17662 ORANGE TREE LN
TUSTIN CA
92780-2315
US

V. Phone/Fax

Practice location:
  • Phone: 714-897-0996
  • Fax:
Mailing address:
  • Phone: 858-205-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT33964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: