Healthcare Provider Details

I. General information

NPI: 1073015954
Provider Name (Legal Business Name): YENG SEE LOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E CESAR CHAVEZ BLVD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

2760 SEQUOIA AVE
SANGER CA
93657-3861
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-7180
  • Fax:
Mailing address:
  • Phone: 559-473-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95433246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: