Basic Information
| Provider Information | |||||||||
| NPI: | 1063978880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YANG | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | JANET | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 COLUMBUS CIR STE 203 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457011371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402494122 | ||||||||
| FaxNumber: | 7402492146 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405929204 | ||||||||
| FaxNumber: | 7405929286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2019 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.