Healthcare Provider Details

I. General information

NPI: 1104337104
Provider Name (Legal Business Name): MAI XAE YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 N MARKS AVE UNIT 110
FRESNO CA
93711-0268
US

IV. Provider business mailing address

3168 ANTONIO AVE
CLOVIS CA
93619-8906
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5437
  • Fax: 559-439-5411
Mailing address:
  • Phone: 559-601-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number153857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: