Provider Demographics
NPI:1821129826
Name:YANG, JEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 BRITTAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3929
Mailing Address - Country:US
Mailing Address - Phone:650-654-3636
Mailing Address - Fax:650-654-2627
Practice Address - Street 1:1178 BRITTAN AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3929
Practice Address - Country:US
Practice Address - Phone:650-654-3636
Practice Address - Fax:650-654-2627
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134221223E0200X
NY050353-11223E0200X
CT0097981223E0200X
CA566811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics