MEDICARE: KELLEY YANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1457150575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY YANG

Provider Business Mailing Address
First Line	:	2033 NEWPORT AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-4832
Country	:	US
Telephone Number	:	916-706-4804
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 68TH AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-5302
Country	:	US
Telephone Number	:	916-477-6146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2025
Last Update Date	:	05/09/2025

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Directions to “ KELLEY YANG ” Practice Location

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