Healthcare Provider Details

I. General information

NPI: 1275669608
Provider Name (Legal Business Name): SHENG AN YANG LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PAUL YANG LMSW

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAFAYETTE AVE SE STE 4000
GRAND RAPIDS MI
49503-4692
US

IV. Provider business mailing address

300 LAFAYETTE AVE SE STE 4000
GRAND RAPIDS MI
49503-4692
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6922
  • Fax: 616-685-5101
Mailing address:
  • Phone: 616-685-6922
  • Fax: 616-685-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801082439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: