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General NPI Number Information
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NPI Number | 1275626012
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Entity Type | Individual
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Provider Name | JAE H YANG MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2203 W.35TH STREET
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City | AUSTIN
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State | TX
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Zip | 78703-5624
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Country | US
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Telephone | 512-374-6701
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Fax | 512-374-6080
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Provider Business Mailing Address
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Address Line | 2203 W 35TH ST
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City | AUSTIN
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State | TX
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Zip | 78703-1203
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Country | US
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Telephone | 512-374-6701
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Fax | 512-374-6080
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E1972
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License Number State | TX
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