Provider Demographics
NPI:1114977733
Name:YANG, JEAN JINQUI (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:JINQUI
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 JERICHO TPKE
Mailing Address - Street 2:UNIT B
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1706
Mailing Address - Country:US
Mailing Address - Phone:516-873-0200
Mailing Address - Fax:516-873-0243
Practice Address - Street 1:153 JERICHO TPKE
Practice Address - Street 2:UNIT B
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1706
Practice Address - Country:US
Practice Address - Phone:516-873-0200
Practice Address - Fax:516-873-0243
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01822619Medicaid
NYG33406Medicare UPIN
NY93T191Medicare ID - Type Unspecified
NY01822619Medicaid