Provider Demographics
NPI:1427375435
Name:YANG, YANG JONG (MD)
Entity type:Individual
Prefix:
First Name:YANG JONG
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1401
Mailing Address - Country:US
Mailing Address - Phone:559-457-5500
Mailing Address - Fax:559-457-5599
Practice Address - Street 1:2505 E DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1401
Practice Address - Country:US
Practice Address - Phone:559-457-5500
Practice Address - Fax:559-457-5599
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117989207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program