Individual
JAE YANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4201 CENTRAL AVE NW STE F1, ALBUQUERQUE, NM 87105-1669
(505) 843-7172
Mailing address
350 N CLARK ST FL 6, CHICAGO, IL 60654-4712
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3920
NM
Other
Enumeration date
06/19/2013
Last updated
08/15/2013
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