Provider Demographics
NPI:1982665444
Name:FANG, YUNG FENG (MD)
Entity Type:Individual
Prefix:
First Name:YUNG
Middle Name:FENG
Last Name:FANG
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 1:121 S 7TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311
Mailing Address - Country:US
Mailing Address - Phone:760-256-2181
Mailing Address - Fax:760-256-2020
Practice Address - Street 1:121 S 7TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311
Practice Address - Country:US
Practice Address - Phone:760-256-2181
Practice Address - Fax:760-256-2020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307210Medicaid
CA00A307210Medicaid