Provider Demographics
NPI:1508517152
Name:YANG, SAMUEL SINANG
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:SINANG
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 1:7940 LITTLE DIPPER AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4125
Mailing Address - Country:US
Mailing Address - Phone:907-337-2331
Mailing Address - Fax:
Practice Address - Street 1:7940 LITTLE DIPPER AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4125
Practice Address - Country:US
Practice Address - Phone:907-337-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 372500000X
AK7422271172A00000X
AK374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore Provider