Provider Demographics
NPI:1568967206
Name:YANG, ALBERT JEN-CHU (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JEN-CHU
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 1:7924 CORAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6757
Mailing Address - Country:US
Mailing Address - Phone:718-450-7274
Mailing Address - Fax:
Practice Address - Street 1:5461 MERIDIAN MARK RD STE 130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3009
Practice Address - Country:US
Practice Address - Phone:404-591-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA93802207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA93802OtherGEORGIA MEDICAL BOARD