Provider Demographics
NPI:1053487504
Name:YANGROB'S MEDICAL INC
Entity Type:Organization
Organization Name:YANGROB'S MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-433-0678
Mailing Address - Street 1:2619 S WATERMAN AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3737
Mailing Address - Country:US
Mailing Address - Phone:909-433-0678
Mailing Address - Fax:909-433-0680
Practice Address - Street 1:2619 S WATERMAN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3737
Practice Address - Country:US
Practice Address - Phone:909-433-0678
Practice Address - Fax:909-433-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641330Medicaid
CA00A641330Medicaid
CAH08285Medicare UPIN