1730166414 NPI number — DR. JUN YANG M D

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730166414 NPI number — DR. JUN YANG M D

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

YANG

Provider First Name:

JUN

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M D

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1730166414

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/30/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

55 NORTH GILBERT STREET

Provider Second Line Business Mailing Address:

SUITE 1201 BLDG #1 SECOND FLOOR

Provider Business Mailing Address City Name:

TINTON FALLS

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

07701

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

732-747-8188

Provider Business Mailing Address Fax Number:

732-747-5946

Provider First Line Business Practice Location Address:

55 NORTH GILBERT STREET

Provider Second Line Business Practice Location Address:

SUITE 1201 BLDG #1 SECOND FLOOR

Provider Business Practice Location Address City Name:

TINTON FALLS

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

07701-4960

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

732-747-8188

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

12/23/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207KA0200X , with the licence number:  MA078974 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 306397 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 60024315 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: P2907113 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 8828709 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 01004850000 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2720467000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 36975 . This is a "UNIVERSITY HREALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 7868403 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0112365 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 3K9477 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 5678954 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2326435 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".