MEDICARE: YP CRABB PHD PORFESSIONAL CORPORATION

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	261Q00000X	Clinic/Center	PY0523	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11828806	OTHER	NV	CAQH

General Provider Information

NPI Number	:	1740459908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YP CRABB PHD PORFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3311 S RAINBOW BLVD STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6596
Country	:	US
Telephone Number	:	702-685-5668
Fax Number	:	702-685-0534

Provider Business Practice Location Address
First Line	:	3311 S RAINBOW BLVD STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6596
Country	:	US
Telephone Number	:	702-685-5668
Fax Number	:	702-685-0534

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YANGCHA P. CRABB
Credential	:	PHD
Telephone Number	:	702-685-5668

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	06/21/2011

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