Healthcare Provider Details

I. General information

NPI: 1235262759
Provider Name (Legal Business Name): CHONG YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 CREOLE CT 1400 K. STREET
MODESTO CA
95355-8720
US

IV. Provider business mailing address

2109 CREOLE CT
MODESTO CA
95355-8720
US

V. Phone/Fax

Practice location:
  • Phone: 209-523-4573
  • Fax:
Mailing address:
  • Phone: 209-551-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 44183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: