Provider Demographics
NPI:1790775674
Name:YANG, DIANE LE (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LE
Last Name:YANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DONG-ANH
Other - Middle Name:CHI
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7276 KAMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-5146
Mailing Address - Country:US
Mailing Address - Phone:858-586-1758
Mailing Address - Fax:858-586-1758
Practice Address - Street 1:5405 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-2304
Practice Address - Country:US
Practice Address - Phone:619-229-6689
Practice Address - Fax:619-286-1659
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12831T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist