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General NPI Number Information
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NPI Number | 1205365103
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Entity Type | Individual
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Provider Name | JESSIE YANG DDS
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Gender | Female
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 09/25/2022
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Provider Practice Location Address
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Address Line | 1517 W 6TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90017-1708
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Country | US
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Telephone | 213-463-2744
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Fax |
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Provider Business Mailing Address
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Address Line | 1633 S MERIDIAN AVE
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City | ALHAMBRA
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State | CA
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Zip | 91803-2632
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Country | US
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Telephone | 510-303-2931
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 103664
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License Number State | CA
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