Basic Information
| Provider Information | |||||||||
| NPI: | 1962861161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YANG | ||||||||
| FirstName: | HEUNG SUK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5150 VILLAGE PARK DR SE | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980066652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256570620 | ||||||||
| FaxNumber: | 4255028425 | ||||||||
| Practice Location | |||||||||
| Address1: | 5150 VILLAGE PARK DR SE | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980066652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256570620 | ||||||||
| FaxNumber: | 4255028425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2016 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.