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General NPI Number Information
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NPI Number | 1538559018
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Entity Type | Organization
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Legal Business Name | SUMMIT PAIN ALLIANCE INC
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 157 LYNCH CREEK WAY
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City | PETALUMA
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State | CA
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Zip | 94954-2342
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Country | US
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Telephone | 707-658-2709
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Fax | 707-981-8950
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Provider Business Mailing Address
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Address Line | 392 TESCONI CT
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City | SANTA ROSA
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State | CA
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Zip | 95401-4653
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Country | US
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Telephone | 707-623-9803
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Fax | 707-843-3257
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL ISHU YANG
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Credential | MD
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Telephone | 707-658-2709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A114663
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A112702
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License Number State | CA
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