Healthcare Provider Details

I. General information

NPI: 1255539532
Provider Name (Legal Business Name): JONATHAN CHRISTIAN YANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E VIRGINIA AVE SUITE 100
PHOENIX AZ
85004-1214
US

IV. Provider business mailing address

370 E VIRGINIA AVE 100
PHOENIX AZ
85004-1214
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-4788
  • Fax: 602-258-5131
Mailing address:
  • Phone: 602-258-4788
  • Fax: 602-258-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number47406
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number47406
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: