Healthcare Provider Details

I. General information

NPI: 1538623145
Provider Name (Legal Business Name): JOHNNY MENG YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 N FRESNO ST
FRESNO CA
93703-1123
US

IV. Provider business mailing address

2934 N FRESNO ST
FRESNO CA
93703-1123
US

V. Phone/Fax

Practice location:
  • Phone: 559-549-6697
  • Fax:
Mailing address:
  • Phone: 559-549-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number140037
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number6F9F5E485D
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: