Healthcare Provider Details

I. General information

NPI: 1124678792
Provider Name (Legal Business Name): PAHOUA YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E. KINGS CANYON RD
FRESNO CA
93702
US

IV. Provider business mailing address

4890 E OLIVE AVE
FRESNO CA
93727-1809
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-1008
  • Fax:
Mailing address:
  • Phone: 559-250-9617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number730470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: