Provider Demographics
NPI:1982160529
Name:YANG, MAI CHONG (LAC)
Entity Type:Individual
Prefix:
First Name:MAI CHONG
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 VILLA WAY APT 358
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2150
Mailing Address - Country:US
Mailing Address - Phone:715-302-4226
Mailing Address - Fax:
Practice Address - Street 1:832 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7759
Practice Address - Country:US
Practice Address - Phone:715-303-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI961-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist