Provider Demographics
NPI:1033230834
Name:YANG, MARK MYOUNG KYO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MYOUNG KYO
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:MYOUNG-KYO
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:213 W BRIER CIR
Mailing Address - Street 2:FRESNO
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6926
Mailing Address - Country:US
Mailing Address - Phone:559-435-6938
Mailing Address - Fax:
Practice Address - Street 1:213 W BRIER CIR
Practice Address - Street 2:FRESNO
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6926
Practice Address - Country:US
Practice Address - Phone:559-435-6938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE30324208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A303240Medicaid
CA00A303240Medicare ID - Type Unspecified
CA00A303240Medicaid