Provider Demographics
NPI:1992843916
Name:YANG, PHYLLIS JACQUELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:JACQUELYN
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 1:20670 CARNIEL AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3735
Mailing Address - Country:US
Mailing Address - Phone:408-334-5528
Mailing Address - Fax:
Practice Address - Street 1:875 BLAKE WILBUR DR
Practice Address - Street 2:#2234
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5826
Practice Address - Country:US
Practice Address - Phone:650-723-8462
Practice Address - Fax:650-736-7562
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA850022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAV744SMedicare PIN
CAAV744WMedicare PIN
CAAV744UMedicare PIN
CAAV744TMedicare PIN
CAAV744VMedicare PIN
CAAV744XMedicare PIN
CAAV744YMedicare PIN
CAAV744ZMedicare PIN