Provider Demographics
NPI:1548365034
Name:YANG, DAVID CHENG-I (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHENG-I
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 1:11716 OLD EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-8354
Mailing Address - Country:US
Mailing Address - Phone:916-266-9057
Mailing Address - Fax:
Practice Address - Street 1:11716 OLD EUREKA WAY
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-8354
Practice Address - Country:US
Practice Address - Phone:916-266-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 53216207R00000X
OH35-065443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0944705Medicaid
OH0944705Medicaid
OH0944705Medicaid