Provider Demographics
NPI:1053496638
Name:WANG, YANG-CHEGN (MD)
Entity Type:Individual
Prefix:
First Name:YANG-CHEGN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 SMILEY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6532
Mailing Address - Country:US
Mailing Address - Phone:909-793-8046
Mailing Address - Fax:909-793-8046
Practice Address - Street 1:1641 SMILEY HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6532
Practice Address - Country:US
Practice Address - Phone:909-793-8046
Practice Address - Fax:909-793-8046
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321410Medicaid
CAA26710Medicare ID - Type Unspecified