Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F308815-1 | NY |
NPI | 1053895904 |
---|---|
Provider Name | Ms. Jiyoung Jeong Yang |
First Address | Forest Hills, NY 11375-4334 |
Second Address | Brentwood, NY 11717-4511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2018 |
Last Update Date | 17/09/2018 |