Provider Demographics
NPI:1073236295
Name:YANG, MINJI (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:MINJI
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 SPAR AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1643
Mailing Address - Country:US
Mailing Address - Phone:510-320-3086
Mailing Address - Fax:
Practice Address - Street 1:390 SPAR AVE STE 104
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1643
Practice Address - Country:US
Practice Address - Phone:510-320-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30069103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling