Provider Demographics
NPI:1528096716
Name:YUO, JAN JENG (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:JENG
Last Name:YUO
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:JAN
Other - Middle Name:CHENG-CHING
Other - Last Name:JENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:2490 HONOLULU AVE
Mailing Address - Street 2:SUITE 128
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1800
Mailing Address - Country:US
Mailing Address - Phone:818-330-9960
Mailing Address - Fax:818-330-9963
Practice Address - Street 1:2490 HONOLULU AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1800
Practice Address - Country:US
Practice Address - Phone:818-330-9960
Practice Address - Fax:818-330-9963
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37730207R00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377301Medicaid
CA110198628Medicare PIN
CAE88919Medicare UPIN
CA00A377301Medicaid