Healthcare Provider Details

I. General information

NPI: 1114647468
Provider Name (Legal Business Name): JALIAH BAOBY YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 WILLIAMSBOURGH DR
SACRAMENTO CA
95823-2006
US

IV. Provider business mailing address

2750 SUTTERVILLE RD
SACRAMENTO CA
95820-1093
US

V. Phone/Fax

Practice location:
  • Phone: 916-662-0614
  • Fax:
Mailing address:
  • Phone: 916-452-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: