Provider Demographics
NPI:1104337104
Name:YANG, MAI XAE
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:XAE
Last Name:YANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3168 ANTONIO AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8906
Mailing Address - Country:US
Mailing Address - Phone:559-601-9900
Mailing Address - Fax:
Practice Address - Street 1:7120 N MARKS AVE UNIT 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0268
Practice Address - Country:US
Practice Address - Phone:559-439-5437
Practice Address - Fax:559-439-5411
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153857106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist