Healthcare Provider Details

I. General information

NPI: 1780495994
Provider Name (Legal Business Name): JIA X YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 TELEGRAPH AVE
BERKELEY CA
94704-3323
US

IV. Provider business mailing address

2655 TELEGRAPH AVE
BERKELEY CA
94704-3323
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-9063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: