=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386261063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YUNG-EN PERNG
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2020
-----------------------------------------------------
Last Update Date | 07/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1241 SOLANO AVE APT 24
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94706-1742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-331-4689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1241 SOLANO AVE APT 24
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94706-1742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-331-4689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | YUNG-EN PERNG
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 949-331-4689
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------