MEDICARE: TRAN LUU YANG BCBA

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	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst	1-13-13165	CA
3	103K00000X	Behavior Analyst
4	103TC0700X	Clinical Psychologist	3677	OR

General Provider Information

NPI Number	:	1982946588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAN LUU YANG BCBA

Provider Business Mailing Address
First Line	:	11943 CENTRALIA ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90715-1435
Country	:	US
Telephone Number	:	562-739-4931
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 CARNEGIE AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5504
Country	:	US
Telephone Number	:	562-739-4931
Fax Number	:

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

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	09/22/2023

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