Provider Demographics
NPI:1548346695
Name:YANG, TOM (MD)
Entity type:Individual
Prefix:DR
First Name:TOM
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:PO BOX 6758
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-6758
Mailing Address - Country:US
Mailing Address - Phone:559-623-9636
Mailing Address - Fax:
Practice Address - Street 1:503 S. WATSON ST.
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-623-9636
Practice Address - Fax:559-623-9951
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88613207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BY8990738OtherDEA
BY8990738OtherDEA