Provider Demographics
NPI:1053430553
Name:YANG, CHIANN-WEN (OD)
Entity type:Individual
Prefix:DR
First Name:CHIANN-WEN
Middle Name:
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 1:125 BELVALE DR
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5112
Mailing Address - Country:US
Mailing Address - Phone:408-365-4120
Mailing Address - Fax:408-227-1681
Practice Address - Street 1:5630 COTTLE ROAD
Practice Address - Street 2:LOCATED INSIDE TARGET
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123
Practice Address - Country:US
Practice Address - Phone:408-227-1681
Practice Address - Fax:408-227-1681
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3754152W00000X
CAOPT 11985 TPL152W00000X
GAOPT002035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA208254OtherEYEMED