Provider Demographics
NPI:1497783773
Name:YANG, RONG (MD)
Entity Type:Individual
Prefix:DR
First Name:RONG
Middle Name:
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 1:2650 JONES WAY STE 24
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1224
Mailing Address - Country:US
Mailing Address - Phone:805-210-7107
Mailing Address - Fax:805-582-0251
Practice Address - Street 1:2650 JONES WAY SUITE 24
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-210-7107
Practice Address - Fax:805-582-0251
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61906208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A619060Medicaid
CA00A619060Medicaid
CAWA61906CMedicare ID - Type Unspecified