Basic Information
| Provider Information | |||||||||
| NPI: | 1649236076 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SUN | ||||||||
| FirstName: | YANG | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 COFFEE ROAD | ||||||||
| Address2: | C3 | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953554241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095299603 | ||||||||
| FaxNumber: | 2095296610 | ||||||||
| Practice Location | |||||||||
| Address1: | 845 JACKSON STREET | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941334899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159822400 | ||||||||
| FaxNumber: | 4152174183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 11/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 29982 | AZ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | A77809 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 642381 | 05 | AZ | MEDICAID |