Healthcare Provider Details

I. General information

NPI: 1063978880
Provider Name (Legal Business Name): JESSICA JANET YANG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2019
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30207 US2
SULTAN WA
98294-8693
US

IV. Provider business mailing address

30207 US2
SULTAN WA
98294-8693
US

V. Phone/Fax

Practice location:
  • Phone: 360-793-0201
  • Fax:
Mailing address:
  • Phone: 360-793-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61452329
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: