Healthcare Provider Details

I. General information

NPI: 1508517152
Provider Name (Legal Business Name): SAMUEL SINANG YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 LITTLE DIPPER AVE
ANCHORAGE AK
99504-4125
US

IV. Provider business mailing address

7940 LITTLE DIPPER AVE
ANCHORAGE AK
99504-4125
US

V. Phone/Fax

Practice location:
  • Phone: 907-337-2331
  • Fax:
Mailing address:
  • Phone: 907-337-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number7422271
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: