Provider Demographics
NPI:1043408370
Name:YANG, TAESEOB
Entity Type:Individual
Prefix:
First Name:TAESEOB
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 HUNTINGTON DR.
Mailing Address - Street 2:101
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5468
Mailing Address - Country:US
Mailing Address - Phone:626-441-1611
Mailing Address - Fax:
Practice Address - Street 1:1445 HUNTINGTON DR
Practice Address - Street 2:101
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4553
Practice Address - Country:US
Practice Address - Phone:626-441-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist