Healthcare Provider Details

I. General information

NPI: 1023168291
Provider Name (Legal Business Name): MR. VANG T YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 E INYO ST
FRESNO CA
93702-2977
US

IV. Provider business mailing address

2423 N SONORA AVE
FRESNO CA
93722-6849
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-3509
  • Fax: 559-453-9049
Mailing address:
  • Phone: 559-271-4596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: