Healthcare Provider Details

I. General information

NPI: 1790171718
Provider Name (Legal Business Name): YALAN CHIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 DOGWOOD MILE ST
LAURINBURG NC
28352-5521
US

IV. Provider business mailing address

1700 DOGWOOD MILE ST
LAURINBURG NC
28352-5521
US

V. Phone/Fax

Practice location:
  • Phone: 910-277-5273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT -2601
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: