Provider Demographics
NPI:1558686527
Name:YANG, JENNIFER W (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
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 1:2837 NW LACAMAS DR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7629
Mailing Address - Country:US
Mailing Address - Phone:920-540-1533
Mailing Address - Fax:
Practice Address - Street 1:2312 NE 129TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3236
Practice Address - Country:US
Practice Address - Phone:360-514-7060
Practice Address - Fax:360-729-3162
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD216565207L00000X
390200000X
WA60453954207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program