=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518122308
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XING YANG M.D.,PH.D.,M.S.P.H.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2008
-----------------------------------------------------
Last Update Date | 11/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25965 NORMANDIE AVE N BLDG 2, 1ST FL
-----------------------------------------------------
City | HARBOR CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90710-3416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-517-3739
-----------------------------------------------------
Fax | 310-517-3742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25965 NORMANDIE AVE N BLDG 2, 1ST FL
-----------------------------------------------------
City | HARBOR CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90710-3416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-517-3739
-----------------------------------------------------
Fax | 310-517-3742
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | 44318
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | A117658
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------