=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912084534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENCHEN YANG M.D., PH.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 654 N DIAMOND BAR BLVD
-----------------------------------------------------
City | DIAMOND BAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91765-1037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-396-8228
-----------------------------------------------------
Fax | 909-396-8227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 654 N DIAMOND BAR BLVD
-----------------------------------------------------
City | DIAMOND BAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91765-1037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-396-8228
-----------------------------------------------------
Fax | 909-396-8227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | A44181
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------