Provider Demographics
NPI:1548782840
Name:YANG, JOSHUA WONJOON
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:WONJOON
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 1:5635 PARVIEW DR APT 112
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2847
Mailing Address - Country:US
Mailing Address - Phone:440-228-5536
Mailing Address - Fax:
Practice Address - Street 1:5635 PARVIEW DR APT 112
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2847
Practice Address - Country:US
Practice Address - Phone:440-228-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-09
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist