Provider Demographics
NPI:1902998370
Name:C J CALVIN YANG, M D A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:C J CALVIN YANG, M D A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIEH-JEN
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-572-2889
Mailing Address - Street 1:320 S GARFIELD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3886
Mailing Address - Country:US
Mailing Address - Phone:626-281-4487
Mailing Address - Fax:626-457-5630
Practice Address - Street 1:320 S GARFIELD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3886
Practice Address - Country:US
Practice Address - Phone:626-281-4487
Practice Address - Fax:626-457-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45194174400000X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A451940Medicaid
CAA54873Medicare UPIN
CAA45194Medicare PIN
CAW20060Medicare PIN
CAWA45194AMedicare PIN