Provider Demographics
NPI:1770539553
Name:YANG, SEO M (MD)
Entity type:Individual
Prefix:MR
First Name:SEO
Middle Name:M
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:PO BOX 2858
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-2858
Mailing Address - Country:US
Mailing Address - Phone:661-729-6854
Mailing Address - Fax:661-729-6864
Practice Address - Street 1:44301 LORIMER AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3700
Practice Address - Country:US
Practice Address - Phone:661-940-1112
Practice Address - Fax:661-723-6402
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30954207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A309540Medicaid
A26293Medicare UPIN
CAP00388769Medicare PIN
CA00A309540Medicaid
CA00A309543Medicare PIN