Provider Demographics
NPI:1043440084
Name:YANG, JUN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUN
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S RAYMOND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7146
Mailing Address - Country:US
Mailing Address - Phone:626-658-7758
Mailing Address - Fax:626-741-5344
Practice Address - Street 1:25 S RAYMOND AVE STE 201
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7146
Practice Address - Country:US
Practice Address - Phone:626-658-7758
Practice Address - Fax:626-741-5344
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 1089682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL12819Medicaid
CADL12819Medicaid