Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | A105550 | CA |
NPI | 1093918112 |
---|---|
Provider Name | Li Yang |
First Address | La Palma, CA 90623-1728 |
Second Address | Monterey Park, CA 91754-6344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A105550 | STATE LICENSE (01) | CA |
FM566Z | MEDICARE PTAN (01) | CA |
FY1264679 | DEA # (01) | CA |