Provider Demographics
NPI:1073577508
Name:YANG, PAUL REN-GING (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:REN-GING
Last Name:YANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5636 E LA PALMA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2114
Mailing Address - Country:US
Mailing Address - Phone:714-970-0274
Mailing Address - Fax:714-970-0629
Practice Address - Street 1:5636 E LA PALMA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2114
Practice Address - Country:US
Practice Address - Phone:714-970-0274
Practice Address - Fax:714-970-0629
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA9514T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073577508Medicaid
CA9514TOtherSTATE LICENSE NUMBER
CA9514TOtherSTATE LICENSE NUMBER
CA9514TOtherSTATE LICENSE NUMBER