Provider Demographics
NPI:1407023351
Name:YANG, KHOUA (MSW)
Entity Type:Individual
Prefix:
First Name:KHOUA
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 N PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6954
Mailing Address - Country:US
Mailing Address - Phone:209-953-8864
Mailing Address - Fax:
Practice Address - Street 1:4422 N PERSHING AVE STE D2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6967
Practice Address - Country:US
Practice Address - Phone:209-953-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker