Healthcare Provider Details

I. General information

NPI: 1710388947
Provider Name (Legal Business Name): LANG FANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 E KINGS CANYON RD
FRESNO CA
93727-3811
US

IV. Provider business mailing address

4879 E KINGS CANYON RD
FRESNO CA
93727-3811
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-8395
  • Fax: 559-452-8062
Mailing address:
  • Phone: 559-255-8395
  • Fax: 559-452-8062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW70183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: