Healthcare Provider Details

I. General information

NPI: 1053233221
Provider Name (Legal Business Name): HUEZONG YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MORNINGSIDE DR
NEW YORK NY
10027-6012
US

IV. Provider business mailing address

2109 N 38TH ST
MILWAUKEE WI
53208-1330
US

V. Phone/Fax

Practice location:
  • Phone: 414-935-8242
  • Fax:
Mailing address:
  • Phone: 414-935-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132448
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: