Provider Demographics
NPI:1760403414
Name:YANG, JENN-TIH (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENN-TIH
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14785 JEFFREY RD STE 108
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0410
Mailing Address - Country:US
Mailing Address - Phone:949-857-2221
Mailing Address - Fax:949-857-2227
Practice Address - Street 1:14785 JEFFREY RD STE 108
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0410
Practice Address - Country:US
Practice Address - Phone:949-857-2221
Practice Address - Fax:949-857-2227
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT17502Medicare ID - Type UnspecifiedPHYSICAL THERAPIST