Provider Demographics
NPI:1134169188
Name:YANG, JOO-SOCK (MD)
Entity type:Individual
Prefix:
First Name:JOO-SOCK
Middle Name:
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 1:1630 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3713
Mailing Address - Country:US
Mailing Address - Phone:415-563-0300
Mailing Address - Fax:415-563-0308
Practice Address - Street 1:1630 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3713
Practice Address - Country:US
Practice Address - Phone:415-563-0300
Practice Address - Fax:415-563-0308
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA00337780Medicaid
CAC03923Medicare UPIN
CA00A337780Medicare ID - Type Unspecified