Provider Demographics
NPI:1235262759
Name:YANG, CHONG
Entity Type:Individual
Prefix:
First Name:CHONG
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 1:2109 CREOLE CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8720
Mailing Address - Country:US
Mailing Address - Phone:209-551-2441
Mailing Address - Fax:
Practice Address - Street 1:2109 CREOLE CT
Practice Address - Street 2:1400 K. STREET
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-8720
Practice Address - Country:US
Practice Address - Phone:209-523-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist