Provider Demographics
NPI:1912664855
Name:YANG, JENNIFER JEONGUN (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEONGUN
Last Name:YANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11950 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1239
Mailing Address - Country:US
Mailing Address - Phone:714-893-4196
Mailing Address - Fax:
Practice Address - Street 1:11950 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1239
Practice Address - Country:US
Practice Address - Phone:714-893-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist