=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982646022
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHIEH-JEN CALVIN YANG MD.,
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 08/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 S GARFIELD AVE SUITE #102
-----------------------------------------------------
City | ALHAMBRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91801-3886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-281-4487
-----------------------------------------------------
Fax | 626-457-5630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 S GARFIELD AVE SUITE #102
-----------------------------------------------------
City | ALHAMBRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91801-3886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-281-4487
-----------------------------------------------------
Fax | 626-457-5630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | A45194
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------