Provider Demographics
NPI:1700510146
Name:ANG, YEN (DRPH, MPH, MS, RD, F)
Entity Type:Individual
Prefix:
First Name:YEN
Middle Name:
Last Name:ANG
Suffix:
Gender:F
Credentials:DRPH, MPH, MS, RD, F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26265 CRESTHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4139
Mailing Address - Country:US
Mailing Address - Phone:909-488-2534
Mailing Address - Fax:
Practice Address - Street 1:550 W MERRILL ST STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1443
Practice Address - Country:US
Practice Address - Phone:254-415-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
983710133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD6628380OtherDRIVER'S LICENSE