Provider Demographics
NPI:1881603629
Name:YANG, JA (PA)
Entity type:Individual
Prefix:
First Name:JA
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 MARYSVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-4512
Mailing Address - Country:US
Mailing Address - Phone:916-563-7230
Mailing Address - Fax:916-563-7229
Practice Address - Street 1:3811 FLORIN RD STE 9
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1818
Practice Address - Country:US
Practice Address - Phone:916-427-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16813363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ06263Medicare UPIN
CAOPA168130Medicare ID - Type UnspecifiedCA MEDICARE