Provider Demographics
NPI:1336697242
Name:YANG, YOUNG JUN
Entity Type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:JUN
Last Name:YANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 PRISCILLAS VW
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-5140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9192 RED BRANCH RD
Practice Address - Street 2:#140
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2030
Practice Address - Country:US
Practice Address - Phone:703-647-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02339171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist