Provider Demographics
NPI:1770653396
Name:YUNG, JASON MOY (RPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MOY
Last Name:YUNG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250610
Mailing Address - Street 2:SFO MEDICAL CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94125-0610
Mailing Address - Country:US
Mailing Address - Phone:650-821-5640
Mailing Address - Fax:650-821-5662
Practice Address - Street 1:TERMINAL 2 LOWER LEVEL
Practice Address - Street 2:SAN FRANCISCO INTERNATIONAL AIRPORT
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94128
Practice Address - Country:US
Practice Address - Phone:650-821-5640
Practice Address - Fax:650-821-5662
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
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
CA0PT128910OtherBLUE SHIELD OF CA
CAPT12891OtherCA PHYSICAL THERAPY BD