Healthcare Provider Details

I. General information

NPI: 1902761224
Provider Name (Legal Business Name): MENDY YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N7321 DEERFIELD LN
SHEBOYGAN WI
53083-5549
US

IV. Provider business mailing address

N7321 DEERFIELD LN
SHEBOYGAN WI
53083-5549
US

V. Phone/Fax

Practice location:
  • Phone: 920-316-5955
  • Fax:
Mailing address:
  • Phone: 920-316-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17705-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: