Provider Demographics
NPI:1841570116
Name:YANG, CLINTON WADE
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:WADE
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 1:6424 WESTSIDE RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-4833
Mailing Address - Country:US
Mailing Address - Phone:530-936-7778
Mailing Address - Fax:
Practice Address - Street 1:6424 WESTSIDE RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-4833
Practice Address - Country:US
Practice Address - Phone:530-936-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist