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General NPI Number Information
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NPI Number | 1134117633
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Entity Type | Individual
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Provider Name | JESSICA YANG O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 2321 FOREST DR STE E
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4679
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Country | US
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Telephone | 410-266-3369
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Fax | 410-266-9448
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Provider Business Mailing Address
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Address Line | 12150 ANNAPOLIS RD STE 111
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City | GLENN DALE
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State | MD
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Zip | 20769-9183
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Country | US
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Telephone | 301-779-0844
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV-6853
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA2079
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License Number State | MD
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