Healthcare Provider Details

I. General information

NPI: 1295513661
Provider Name (Legal Business Name): BAO YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date: 08/06/2025
Reactivation Date: 08/21/2025

III. Provider practice location address

12200 E 13 MILE RD
WARREN MI
48093-3093
US

IV. Provider business mailing address

12200 E 13 MILE RD
WARREN MI
48093-3093
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-1810
  • Fax:
Mailing address:
  • Phone: 586-573-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: