Provider Demographics
NPI:1255309092
Name:YANG, JUNG-I (MD)
Entity Type:Individual
Prefix:DR
First Name:JUNG-I
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 1:22 ODYSSEY
Mailing Address - Street 2:SUITE 245
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3186
Mailing Address - Country:US
Mailing Address - Phone:949-552-5108
Mailing Address - Fax:949-552-0284
Practice Address - Street 1:22 ODYSSEY
Practice Address - Street 2:SUITE 245
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3186
Practice Address - Country:US
Practice Address - Phone:949-552-5108
Practice Address - Fax:949-552-0284
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43882207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A438820Medicaid
CAC30599Medicare UPIN
CA00A438820Medicaid