MEDICARE: YOON HO YANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI02772700	NJ

General Provider Information

NPI Number	:	1629611678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOON HO YANG

Provider Business Mailing Address
First Line	:	1575 HARBOR BLVD APT 3812
Second Line	:
City	:	WEEHAWKEN
State	:	NJ
Zip	:	07086-6671
Country	:	US
Telephone Number	:	313-670-9546
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 ENGLISH CREEK AVE
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-4863
Country	:	US
Telephone Number	:	609-484-5996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	10/22/2019

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