Provider Demographics
NPI:1225274624
Name:FANG, YICHUN MICHELLE (RN)
Entity Type:Individual
Prefix:MS
First Name:YICHUN
Middle Name:MICHELLE
Last Name:FANG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 3082
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5207
Mailing Address - Country:US
Mailing Address - Phone:310-345-3818
Mailing Address - Fax:310-314-2414
Practice Address - Street 1:2716 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 3082
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5207
Practice Address - Country:US
Practice Address - Phone:310-345-3818
Practice Address - Fax:310-314-2414
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA680110163WG0000X
CA18462163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice