Provider Demographics
NPI:1952365025
Name:YANG, JACK C (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:C
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4077 FIFTH AVE
Mailing Address - Street 2:MER 62
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2105
Mailing Address - Country:US
Mailing Address - Phone:619-548-0450
Mailing Address - Fax:888-900-0442
Practice Address - Street 1:4033 3RD AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2117
Practice Address - Country:US
Practice Address - Phone:619-548-0450
Practice Address - Fax:888-900-0442
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2017-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG730022086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G730020Medicaid
CAG07986Medicare UPIN