Healthcare Provider Details

I. General information

NPI: 1568967206
Provider Name (Legal Business Name): ALBERT JEN-CHU YANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE S STE 125
JACKSONVILLE FL
32250
US

IV. Provider business mailing address

1361 13TH AVE S FL 32250
JACKSONVILLE BEACH FL
32250-3233
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-2580
  • Fax:
Mailing address:
  • Phone: 904-249-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number93802
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME165435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: