Provider Demographics
NPI:1386719060
Name:YANG, JIE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JIE
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WASHINGTON ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2700
Mailing Address - Country:US
Mailing Address - Phone:860-886-8362
Mailing Address - Fax:860-886-9262
Practice Address - Street 1:330 WASHINGTON ST STE 220
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2700
Practice Address - Country:US
Practice Address - Phone:860-886-8362
Practice Address - Fax:860-886-9262
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062973207R00000X
CT045298207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT9906067OtherAETNA
CT001452987Medicaid
CT010045298CT01OtherBLUE CROSS BLUE SHIELD
CT830000186Medicare PIN