Healthcare Provider Details

I. General information

NPI: 1104039874
Provider Name (Legal Business Name): YUET SAU YUNG R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 MANDARIN CT
MODESTO CA
95350-4662
US

IV. Provider business mailing address

1125 MANDARIN CT
MODESTO CA
95350-4662
US

V. Phone/Fax

Practice location:
  • Phone: 209-571-2812
  • Fax:
Mailing address:
  • Phone: 209-571-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number497821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: