Provider Demographics
NPI:1710063334
Name:YANG, VICKY (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKY
Middle Name:
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 1:2900 WHIPPLE AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2851
Mailing Address - Country:US
Mailing Address - Phone:650-365-3700
Mailing Address - Fax:650-368-3836
Practice Address - Street 1:2900 WHIPPLE AVE STE 245
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2851
Practice Address - Country:US
Practice Address - Phone:650-365-3700
Practice Address - Fax:650-368-3836
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG805360207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0025350Medicaid
ZZZ12647ZOtherMEDICARE GRP PIN
CAZZZ12647ZOtherBLUE SHIELD
CAG28535Medicare UPIN
CAGR0025350Medicaid