Healthcare Provider Details

I. General information

NPI: 1265130611
Provider Name (Legal Business Name): SHIZENG YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19114 S SPRINGWATER RD
ESTACADA OR
97023-8667
US

IV. Provider business mailing address

19114 S SPRINGWATER RD
ESTACADA OR
97023-8667
US

V. Phone/Fax

Practice location:
  • Phone: 503-503-7047
  • Fax: 503-200-1422
Mailing address:
  • Phone: 503-503-7047
  • Fax: 503-200-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5118
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: