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General NPI Number Information
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NPI Number | 1396416467
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Entity Type | Individual
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Provider Name | XUE YANG
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Gender | Male
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 1265 GREY FOX RD STE 2
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City | ARDEN HILLS
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State | MN
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Zip | 55112-6929
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Country | US
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Telephone | 651-612-8612
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Fax |
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Provider Business Mailing Address
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Address Line | 6048 UPPER 51ST ST N APT 111
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City | OAKDALE
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State | MN
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Zip | 55128-1310
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Country | US
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Telephone | 608-385-4882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | MN
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