Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D7823 | OR |
Y | 213EG0000X | General Practice | D7823 | OR |
NPI | 1003082652 |
---|---|
Provider Name | Jonathan Yang |
First Address | La Pine, OR 97739-2999 |
Second Address | Lapine, OR 97739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 05/05/2008 |