Provider Demographics
NPI:1528349420
Name:YANG, LUE (PA)
Entity type:Individual
Prefix:
First Name:LUE
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5524 ASSEMBLY CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2625
Mailing Address - Country:US
Mailing Address - Phone:916-642-1867
Mailing Address - Fax:916-428-5088
Practice Address - Street 1:5524 ASSEMBLY CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2625
Practice Address - Country:US
Practice Address - Phone:916-642-1867
Practice Address - Fax:916-428-5088
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21782363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical