Provider Demographics
NPI:1811972417
Name:YEUN, JANE Y (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:Y
Last Name:YEUN
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 1:4150 V ST
Mailing Address - Street 2:NEPHROLOGY DIVISION #3500 PSSB
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-3014
Mailing Address - Fax:916-734-7920
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:NEPHROLOGY DIVISION #3500 PSSB
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-3014
Practice Address - Fax:916-734-7920
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG064337207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG064337OtherMEDICAL LICENSE
CAG39463Medicare UPIN