Healthcare Provider Details

I. General information

NPI: 1972383024
Provider Name (Legal Business Name): YANG VAU CHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SCHELFHOUT LN
KIMBERLY WI
54136-2064
US

IV. Provider business mailing address

3733 N TERRI LN
APPLETON WI
54914-6935
US

V. Phone/Fax

Practice location:
  • Phone: 920-362-0537
  • Fax:
Mailing address:
  • Phone: 920-410-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: