Healthcare Provider Details

I. General information

NPI: 1730166414
Provider Name (Legal Business Name): JUN YANG M D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 NORTH GILBERT STREET SUITE 1201 BLDG #1 SECOND FLOOR
TINTON FALLS NJ
07701-4960
US

IV. Provider business mailing address

55 NORTH GILBERT STREET SUITE 1201 BLDG #1 SECOND FLOOR
TINTON FALLS NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-8188
  • Fax:
Mailing address:
  • Phone: 732-747-8188
  • Fax: 732-747-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMA078974
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: