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General NPI Number Information
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NPI Number | 1972156420
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Entity Type | Individual
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Provider Name | JESSICA R YANG
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Gender | Female
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 06/27/2020
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Provider Practice Location Address
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Address Line | 6950 SANTA TERESA BLVD STE D
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City | SAN JOSE
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State | CA
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Zip | 95119-1300
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Country | US
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Telephone | 408-478-2443
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Fax |
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Provider Business Mailing Address
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Address Line | 37200 PASEO PADRE PKWY APT 155
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City | FREMONT
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State | CA
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Zip | 94536-2575
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Country | US
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Telephone | 949-241-6181
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 104119
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License Number State | CA
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