Healthcare Provider Details

I. General information

NPI: 1023964442
Provider Name (Legal Business Name): JASON YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

515 W 5TH AVE APT 207
COLUMBUS OH
43201-0089
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-3277
  • Fax:
Mailing address:
  • Phone: 909-837-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberVJ878793
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: