Healthcare Provider Details

I. General information

NPI: 1912755778
Provider Name (Legal Business Name): NAI-JIIN YANG EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2463 E GALA ST STE 100
MERIDIAN ID
83642-5210
US

IV. Provider business mailing address

2463 E GALA ST STE 100
MERIDIAN ID
83642-5210
US

V. Phone/Fax

Practice location:
  • Phone: 208-955-7333
  • Fax:
Mailing address:
  • Phone: 208-955-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: