MEDICARE: LEE HOUA YANG

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1750043147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE HOUA YANG

Provider Business Mailing Address
First Line	:	1426 NEW JERSEY AVE
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53081-4843
Country	:	US
Telephone Number	:	920-946-7058
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 NEW JERSEY AVE
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53081-4843
Country	:	US
Telephone Number	:	920-946-7058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2021
Last Update Date	:	10/12/2021

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Directions to “ LEE HOUA YANG ” Practice Location

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