Healthcare Provider Details

I. General information

NPI: 1649581802
Provider Name (Legal Business Name): YANG LEE VANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 NORWOOD AVE
SACRAMENTO CA
95838-2686
US

IV. Provider business mailing address

6433 16TH ST
RIO LINDA CA
95673-4542
US

V. Phone/Fax

Practice location:
  • Phone: 916-614-9502
  • Fax: 916-614-9514
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: