Provider Demographics
NPI:1285181602
Name:YANG, PHOUA
Entity Type:Individual
Prefix:
First Name:PHOUA
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 BRANCH CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3807
Mailing Address - Country:US
Mailing Address - Phone:916-875-0067
Mailing Address - Fax:916-875-8990
Practice Address - Street 1:3701 BRANCH CENTER RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3807
Practice Address - Country:US
Practice Address - Phone:916-875-0067
Practice Address - Fax:916-875-8990
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA756160163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health