Provider Demographics
NPI:1619647112
Name:YANG, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
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 1:2626 FOOTHILL BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3574
Mailing Address - Country:US
Mailing Address - Phone:626-598-9559
Mailing Address - Fax:
Practice Address - Street 1:3650 LOS FELIZ BLVD APT 32
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2431
Practice Address - Country:US
Practice Address - Phone:917-907-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30152OtherSPEECH PATHOLOGIST LICENSE