MEDICARE: MRS. JENN-TIH YANG P.T.

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1760403414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENN-TIH YANG P.T.

Provider Business Mailing Address
First Line	:	14785 JEFFREY RD STE 108
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-0410
Country	:	US
Telephone Number	:	949-857-2221
Fax Number	:	949-857-2227

Provider Business Practice Location Address
First Line	:	14785 JEFFREY RD STE 108
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-0410
Country	:	US
Telephone Number	:	949-857-2221
Fax Number	:	949-857-2227

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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