Healthcare Provider Details

I. General information

NPI: 1508935974
Provider Name (Legal Business Name): THU Y YANG LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE FL 3
LONG BEACH CA
90806-2325
US

IV. Provider business mailing address

6668 GAVIOTA AVE
LONG BEACH CA
90805-1632
US

V. Phone/Fax

Practice location:
  • Phone: 562-256-2980
  • Fax: 562-290-0068
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW85976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: