Healthcare Provider Details

I. General information

NPI: 1467968404
Provider Name (Legal Business Name): CHING CHING YANG CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

5352 DEBRA LN
EL SOBRANTE CA
94803-3488
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1247
  • Fax:
Mailing address:
  • Phone: 510-417-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number95008263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: