Provider Demographics
NPI:1336462100
Name:STANLEY W YANG, MD
Entity Type:Organization
Organization Name:STANLEY W YANG, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-982-4706
Mailing Address - Street 1:1060 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4070
Mailing Address - Country:US
Mailing Address - Phone:909-982-4706
Mailing Address - Fax:909-946-8545
Practice Address - Street 1:530 N FERN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3210
Practice Address - Country:US
Practice Address - Phone:909-986-8818
Practice Address - Fax:909-391-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29756174400000X
CAA297560251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty