Healthcare Provider Details

I. General information

NPI: 1366508558
Provider Name (Legal Business Name): MS. PA FOUA YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 N MILLBROOK AVE
FRESNO CA
93703-1425
US

IV. Provider business mailing address

3147 N MILLBROOK AVE
FRESNO CA
93703-1425
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-3860
  • Fax: 559-453-5700
Mailing address:
  • Phone: 559-453-3860
  • Fax: 559-453-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN195096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: