Provider Demographics
NPI:1063942878
Name:YANG, MENG-JU (PSYD)
Entity type:Individual
Prefix:
First Name:MENG-JU
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 E TASMAN DR, STE20, PMB 210
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134
Mailing Address - Country:US
Mailing Address - Phone:408-351-4051
Mailing Address - Fax:
Practice Address - Street 1:181 E TASMAN DR STE 20
Practice Address - Street 2:PMB 210
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-3389
Practice Address - Country:US
Practice Address - Phone:408-351-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33008103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist