Provider Demographics
NPI:1447602511
Name:YANG, STEPHANIE AMY (OD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:AMY
Last Name:YANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8522 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3335
Mailing Address - Country:US
Mailing Address - Phone:562-696-1883
Mailing Address - Fax:562-616-7028
Practice Address - Street 1:8522 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3335
Practice Address - Country:US
Practice Address - Phone:562-696-1883
Practice Address - Fax:562-616-7028
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33496152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist