Provider Demographics
NPI:1083098958
Name:YANG, FUKUI
Entity Type:Individual
Prefix:
First Name:FUKUI
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 OAK TREE AVE
Mailing Address - Street 2:SUITE O
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5100
Mailing Address - Country:US
Mailing Address - Phone:908-822-8898
Mailing Address - Fax:908-822-8882
Practice Address - Street 1:908 OAK TREE AVE
Practice Address - Street 2:SUITE O
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5100
Practice Address - Country:US
Practice Address - Phone:908-822-8898
Practice Address - Fax:908-822-8882
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00010600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist