Provider Demographics
NPI:1730297227
Name:YANG, VONG JOHNNY (DC)
Entity Type:Individual
Prefix:DR
First Name:VONG
Middle Name:JOHNNY
Last Name:YANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3139 E MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-3161
Mailing Address - Country:US
Mailing Address - Phone:559-486-3894
Mailing Address - Fax:559-486-3895
Practice Address - Street 1:3139 E MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3161
Practice Address - Country:US
Practice Address - Phone:559-486-3894
Practice Address - Fax:559-486-3895
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0295990Medicaid
CADC0295990Medicaid
CAV04895Medicare UPIN
CADC0295991Medicare PIN