Provider Demographics
NPI:1518710920
Name:YANG, KEVIN VONG
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:VONG
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 1:748 BIELENBERG DR STE 140
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1407
Mailing Address - Country:US
Mailing Address - Phone:651-796-2306
Mailing Address - Fax:
Practice Address - Street 1:748 BIELENBERG DR STE 140
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1407
Practice Address - Country:US
Practice Address - Phone:651-796-2306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician