Healthcare Provider Details

I. General information

NPI: 1508398900
Provider Name (Legal Business Name): JAEYOUNG YANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 GATEWAY DR
RIVERSIDE CA
92507-0908
US

IV. Provider business mailing address

2799 GATEWAY DR
RIVERSIDE CA
92507-0908
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax: 833-450-5967
Mailing address:
  • Phone: 888-530-4415
  • Fax: 833-450-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number282393
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: