Provider Demographics
NPI:1659339620
Name:YANG, THERESE HUNLEY (MD)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:HUNLEY
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 MISSION GORGE RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3026
Mailing Address - Country:US
Mailing Address - Phone:619-596-4963
Mailing Address - Fax:619-596-4965
Practice Address - Street 1:10201 MISSION GORGE RD
Practice Address - Street 2:SUITE H
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3026
Practice Address - Country:US
Practice Address - Phone:619-596-4963
Practice Address - Fax:619-596-4965
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15129Medicare ID - Type Unspecified
CAF17140Medicare UPIN