Basic Information
| Provider Information | |||||||||
| NPI: | 1982153805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LU | ||||||||
| FirstName: | YANG | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136-26 37TH AVE | ||||||||
| Address2: | CBWCHC | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188861212 | ||||||||
| FaxNumber: | 7188862568 | ||||||||
| Practice Location | |||||||||
| Address1: | 136-26 37TH AVE | ||||||||
| Address2: | CBWCHC | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188861212 | ||||||||
| FaxNumber: | 7188862568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2016 | ||||||||
| LastUpdateDate: | 10/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 711197 | NY | Y | Nursing Service Providers | Registered Nurse | 163W00000X | RN95096034 | CA | N | Nursing Service Providers | Registered Nurse |
No ID Information.