Provider Demographics
NPI:1083708101
Name:YANG, VANESSA (MS, ATC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 FELSPAR STREET
Mailing Address - Street 2:APT. 3E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DRIVE
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA, SAN DIEGO
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0529
Practice Address - Country:US
Practice Address - Phone:858-822-6747
Practice Address - Fax:858-822-1727
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer