Provider Demographics
NPI:1548220304
Name:YANG, XIAO (MD)
Entity Type:Individual
Prefix:DR
First Name:XIAO
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 1:405 PALMCREST DRIVE, APT 17
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:415-656-9844
Mailing Address - Fax:
Practice Address - Street 1:2260 GLADSTONE DR STE 8
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5125
Practice Address - Country:US
Practice Address - Phone:925-301-8487
Practice Address - Fax:925-301-8268
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430644207R00000X
CAA94954208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200263840AMedicaid
11341402OtherCAQH IDN
KSI13162Medicare UPIN
11341402OtherCAQH IDN