Provider Demographics
NPI:1093873119
Name:YANG, SHU QING (MD)
Entity Type:Individual
Prefix:
First Name:SHU
Middle Name:QING
Last Name: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 1:122 CALISTOGA ROAD #396
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3702
Mailing Address - Country:US
Mailing Address - Phone:707-525-8229
Mailing Address - Fax:707-942-1598
Practice Address - Street 1:122 CALISTOGA ROAD #396
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3702
Practice Address - Country:US
Practice Address - Phone:707-525-8229
Practice Address - Fax:707-942-1598
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67364207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A673640Medicaid
CA00A673640Medicaid
CAH68576Medicare UPIN
CA00A673640Medicaid