Provider Demographics
NPI:1700021987
Name:YANG, JENNY DACI (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:DACI
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KUANG
Other - Middle Name:
Other - Last Name:DACI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2331 MONTPELIER DR STE B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1673
Mailing Address - Country:US
Mailing Address - Phone:408-347-9001
Mailing Address - Fax:408-347-9004
Practice Address - Street 1:2331 MONTPELIER DR STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1673
Practice Address - Country:US
Practice Address - Phone:408-347-9001
Practice Address - Fax:408-347-9004
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119192207RG0100X
TXN6848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB130383Medicare PIN