Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | CA | |
Y | 103T00000X | Psychologist | CA | |
N | 102L00000X | Psychologist | 2012880 | CA |
N | 103T00000X | Psychologist | 2012880 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1306287347 |
---|---|
Provider Name | Cheng Vang |
First Address | Fresno, CA 93727-1526 |
Second Address | Fresno, CA 93703-2123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2013 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
77-0280265 | (05) | CA |