Provider Demographics
NPI:1912480906
Name:YANG, SHANGXIN (PHD, D(ABMM))
Entity Type:Individual
Prefix:DR
First Name:SHANGXIN
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:PHD, D(ABMM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28108 RIDGEFERN CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3266
Mailing Address - Country:US
Mailing Address - Phone:626-202-3167
Mailing Address - Fax:
Practice Address - Street 1:11633 SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6511
Practice Address - Country:US
Practice Address - Phone:310-794-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTA43523246QM0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology