Provider Demographics
NPI:1124856653
Name:YANGO, DYLAN
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:YANGO
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 1:15329 SE 183RD DR
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9642
Mailing Address - Country:US
Mailing Address - Phone:425-902-3064
Mailing Address - Fax:
Practice Address - Street 1:15329 SE 183RD DR
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-9642
Practice Address - Country:US
Practice Address - Phone:425-902-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician