MEDICARE: JACK M YANG MD

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	207Q00000X	Family Medicine Physician	17243	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V74495	OTHER	NV	MEDICARE

General Provider Information

NPI Number	:	1720405830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK M YANG MD

Provider Business Mailing Address
First Line	:	3129 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4578
Country	:	US
Telephone Number	:	725-220-8457
Fax Number	:	833-749-0355

Provider Business Practice Location Address
First Line	:	3129 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4578
Country	:	US
Telephone Number	:	725-220-8457
Fax Number	:	833-749-0355

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

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	08/23/2022

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