MEDICARE: SUSAN YANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1629877113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN YANG

Provider Business Mailing Address
First Line	:	1201 PARNELL PL
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2737
Country	:	US
Telephone Number	:	214-597-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 PARNELL PL
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2737
Country	:	US
Telephone Number	:	214-597-5544
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SUSAN YANG
Credential	:
Telephone Number	:	214-597-5544

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/10/2025

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Directions to “SUSAN YANG ” Practice Location

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