Healthcare Provider Details

I. General information

NPI: 1487387015
Provider Name (Legal Business Name): JIYUN YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14954 TAHOE ST
OZONE PARK NY
11417-3029
US

IV. Provider business mailing address

14954 TAHOE ST
OZONE PARK NY
11417-3029
US

V. Phone/Fax

Practice location:
  • Phone: 347-399-8906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007829
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA74965
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032989
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: