Healthcare Provider Details

I. General information

NPI: 1558686527
Provider Name (Legal Business Name): JENNIFER W YANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 NE 129TH ST
VANCOUVER WA
98686-3236
US

IV. Provider business mailing address

2837 NW LACAMAS DR
CAMAS WA
98607-7629
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7060
  • Fax: 360-729-3162
Mailing address:
  • Phone: 920-540-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD216565
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number60453954
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: