Provider Demographics
NPI:1285063941
Name:YANG, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 JOHNSON BLVD
Mailing Address - Street 2:
Mailing Address - City:S LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8214
Mailing Address - Country:US
Mailing Address - Phone:530-542-7744
Mailing Address - Fax:530-542-7750
Practice Address - Street 1:1020 JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:S LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8214
Practice Address - Country:US
Practice Address - Phone:530-542-7744
Practice Address - Fax:530-542-7750
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist