Provider Demographics
NPI:1700519410
Name:YANG, RICHARD BLUANU
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BLUANU
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 1:3088 ASHCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9285
Mailing Address - Country:US
Mailing Address - Phone:559-720-3191
Mailing Address - Fax:
Practice Address - Street 1:456 S MADERA AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1538
Practice Address - Country:US
Practice Address - Phone:559-846-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist