Provider Demographics
NPI:1033293915
Name:LEE YANG, KIRTINE (MD)
Entity Type:Individual
Prefix:
First Name:KIRTINE
Middle Name:
Last Name:LEE YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S ANAHEIM HILLS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4762
Mailing Address - Country:US
Mailing Address - Phone:714-282-2229
Mailing Address - Fax:877-794-9299
Practice Address - Street 1:500 S ANAHEIM HILLS RD STE 110
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:714-282-2229
Practice Address - Fax:877-794-9299
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901295Medicare ID - Type Unspecified
NC2043407Medicare ID - Type Unspecified
I36950Medicare ID - Type Unspecified