Provider Demographics
NPI:1952475626
Name:YANG, KEE IN (MD)
Entity Type:Individual
Prefix:
First Name:KEE
Middle Name:IN
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 1:6334 MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-4123
Mailing Address - Country:US
Mailing Address - Phone:951-248-9113
Mailing Address - Fax:951-248-9115
Practice Address - Street 1:6334 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-4123
Practice Address - Country:US
Practice Address - Phone:951-248-9113
Practice Address - Fax:951-248-9115
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A38547OtherMEDICARE PTAN
CA00A385470Medicaid
CAA38547Medicare Oscar/Certification
A88466Medicare UPIN
A38547Medicare PIN