Provider Demographics
NPI:1376979443
Name:YANG, BRAD
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:
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 1:8940 67TH WAY N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4517
Mailing Address - Country:US
Mailing Address - Phone:727-777-4241
Mailing Address - Fax:
Practice Address - Street 1:8940 67TH WAY N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4517
Practice Address - Country:US
Practice Address - Phone:727-657-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251J00000X, 253Z00000X, 251E00000X, 343900000X, 305R00000X
332U00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program