MEDICARE: SUMMIT PAIN ALLIANCE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A114663	CA
2	174400000X	Specialist	A112702	CA

General Provider Information

NPI Number	:	1538559018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT PAIN ALLIANCE INC

Provider Business Mailing Address
First Line	:	392 TESCONI CT
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4653
Country	:	US
Telephone Number	:	707-623-9803
Fax Number	:	707-843-3257

Provider Business Practice Location Address
First Line	:	157 LYNCH CREEK WAY
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-2342
Country	:	US
Telephone Number	:	707-658-2709
Fax Number	:	707-981-8950

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL ISHU YANG
Credential	:	MD
Telephone Number	:	707-658-2709

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	04/17/2018

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