Provider Demographics
NPI:1104835388
Name:YANG, PETER T (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:YANG
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 1:399 E HIGHLAND AVE STE 516
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3875
Mailing Address - Country:US
Mailing Address - Phone:909-881-1722
Mailing Address - Fax:909-883-6011
Practice Address - Street 1:399 E HIGHLAND AVE STE 516
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3875
Practice Address - Country:US
Practice Address - Phone:909-881-1722
Practice Address - Fax:909-883-6011
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31215207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2671716Medicaid
CA01303OtherIEHP
CA2671716Medicaid