Provider Demographics
NPI:1659439024
Name:YANG, RONG GOW (REG PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RONG GOW
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:REG PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 NORTHAM DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5075
Mailing Address - Country:US
Mailing Address - Phone:714-680-9185
Mailing Address - Fax:626-288-2549
Practice Address - Street 1:616 N GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1141
Practice Address - Country:US
Practice Address - Phone:626-288-8515
Practice Address - Fax:626-288-2549
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH37745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA343570Medicaid
0590578OtherNABP
0590578OtherNABP