Provider Demographics
NPI:1114952868
Name:YANG, JOHN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:YANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38431 20TH ST E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4034
Mailing Address - Country:US
Mailing Address - Phone:661-267-2158
Mailing Address - Fax:661-267-1736
Practice Address - Street 1:38431 20TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4034
Practice Address - Country:US
Practice Address - Phone:661-267-2158
Practice Address - Fax:661-267-1736
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV09011Medicare UPIN
CADC0298750Medicare ID - Type Unspecified