Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | G61288 | CA |
Y | 207W00000X | Ophthalmologist | G61288 | CA |
NPI | 1043206022 |
---|---|
Provider Name | Dr. Michael Yang |
First Address | Los Angeles, CA 90054-0679 |
Second Address | Beverly Hills, CA 90211-1788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 19/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F01149 | (02) | CA |